Provider Demographics
NPI:1316121247
Name:GARRISON FAMILY MEDICAL GROUP
Entity type:Organization
Organization Name:GARRISON FAMILY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTONETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABATTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-947-7100
Mailing Address - Street 1:41210 11TH ST W
Mailing Address - Street 2:SUITE C
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1447
Mailing Address - Country:US
Mailing Address - Phone:661-947-7100
Mailing Address - Fax:661-947-7670
Practice Address - Street 1:41210 11TH ST W
Practice Address - Street 2:SUITE C
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1447
Practice Address - Country:US
Practice Address - Phone:661-947-7100
Practice Address - Fax:661-947-7670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50780132700000X, 204C00000X, 207K00000X, 207N00000X, 207NI0002X, 207QA0000X, 207QA0401X, 207QA0505X, 207QG0300X, 207QS0010X, 207R00000X, 207V00000X, 208000000X, 208100000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Multi-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Multi-Specialty
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G507800Medicaid
CAG50780Medicare UPIN