Basic Information
Provider Information
NPI: 1932615879
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARRIDO
FirstName: JAIME
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9097 E DESERT COVE AVE STE 110
Address2:  
City: SCOTTSDALE
State: AZ
PostalCode: 852606276
CountryCode: US
TelephoneNumber: 6023298250
FaxNumber:  
Practice Location
Address1: 2301 E YEAGER DR STE 3
Address2:  
City: CHANDLER
State: AZ
PostalCode: 852861578
CountryCode: US
TelephoneNumber: 4803518721
FaxNumber: 4803518722
Other Information
ProviderEnumerationDate: 12/14/2017
LastUpdateDate: 12/14/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X AZY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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