Provider Demographics
NPI:1588743413
Name:GARRITSON, ANGELA FAYE (IDC)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:FAYE
Last Name:GARRITSON
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS HIGGINS DDG-76
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:96667
Mailing Address - Country:US
Mailing Address - Phone:619-556-4528
Mailing Address - Fax:
Practice Address - Street 1:USS HIGGINS DDG-76
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:96667
Practice Address - Country:US
Practice Address - Phone:619-556-4528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman