Provider Demographics
NPI:1285278671
Name:ANZURES, GARRETT
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:ANZURES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28532 FOREST MEADOW PL
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-4313
Mailing Address - Country:US
Mailing Address - Phone:661-476-1842
Mailing Address - Fax:
Practice Address - Street 1:28532 FOREST MEADOW PL
Practice Address - Street 2:
Practice Address - City:CASTAIC
Practice Address - State:CA
Practice Address - Zip Code:91384-4313
Practice Address - Country:US
Practice Address - Phone:661-476-1842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50325225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty