Provider Demographics
NPI:1770784241
Name:GARRETT, MAGGIE ROSE (L AC)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:ROSE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 W EL ROBLAR DR
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2208
Mailing Address - Country:US
Mailing Address - Phone:805-421-6032
Mailing Address - Fax:805-624-6106
Practice Address - Street 1:137 W EL ROBLAR DR
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2208
Practice Address - Country:US
Practice Address - Phone:805-421-6032
Practice Address - Fax:805-624-6106
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11291171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist