Provider Demographics
NPI:1952375420
Name:FLORENCE C. GARROVILLAS,M.D., INC
Entity Type:Organization
Organization Name:FLORENCE C. GARROVILLAS,M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:CALLANTA
Authorized Official - Last Name:GARROVILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-747-7000
Mailing Address - Street 1:160 S FARMERSVILLE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FARMERSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93223-1845
Mailing Address - Country:US
Mailing Address - Phone:559-747-7000
Mailing Address - Fax:559-747-7011
Practice Address - Street 1:160 S FARMERSVILLE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:FARMERSVILLE
Practice Address - State:CA
Practice Address - Zip Code:93223-1845
Practice Address - Country:US
Practice Address - Phone:559-747-7000
Practice Address - Fax:559-747-7011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77326208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101361OtherHEALTHNET OF CA
CAU01143OtherMEDICAL BLUECROSS