Provider Demographics
NPI:1154409654
Name:GARRISON, ROSEANNE (PA-C)
Entity type:Individual
Prefix:MS
First Name:ROSEANNE
Middle Name:
Last Name:GARRISON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3063 CRAPE MYRTLE CIR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-4236
Mailing Address - Country:US
Mailing Address - Phone:323-869-5322
Mailing Address - Fax:323-869-5362
Practice Address - Street 1:5427 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022
Practice Address - Country:US
Practice Address - Phone:323-869-5322
Practice Address - Fax:323-869-5362
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13823363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical