Provider Demographics
NPI:1871605386
Name:WIRTH, GARRETT ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:ANDREW
Last Name:WIRTH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1401 AVOCADO AVE STE 810
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8708
Mailing Address - Country:US
Mailing Address - Phone:949-706-9988
Mailing Address - Fax:949-679-9967
Practice Address - Street 1:1401 AVOCADO AVE STE 810
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8708
Practice Address - Country:US
Practice Address - Phone:949-706-9988
Practice Address - Fax:949-679-9967
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA81620208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA81620AOtherPPIN
CAW15312Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
CAI35917Medicare UPIN