1093914640 NPI number — JOHN LAWRENCE GARWOOD MD A MEDICAL

Table of content: (NPI 1093914640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093914640 NPI number — JOHN LAWRENCE GARWOOD MD A MEDICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN LAWRENCE GARWOOD MD A MEDICAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
J L GARWOOD MD
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093914640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 20TH ST
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
SANTA MONICA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90404-2050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-828-7494
Provider Business Mailing Address Fax Number:
310-315-0290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 20TH ST
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90404-2050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-828-7494
Provider Business Practice Location Address Fax Number:
310-315-0290
Provider Enumeration Date:
07/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GARWOOD
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-828-7494

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  G049986 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G499861 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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