MEDICARE: LUIS OBISPO GARCIA-NIQUE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A33647	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003955519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS OBISPO GARCIA-NIQUE M.D.

Provider Business Mailing Address
First Line	:	801 N. TUSTIN AVE. STE. 204
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3171
Country	:	US
Telephone Number	:	714-527-8827
Fax Number	:	714-527-0208

Provider Business Practice Location Address
First Line	:	801 N TUSTIN AVE STE 204
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3600
Country	:	US
Telephone Number	:	714-527-8827
Fax Number	:	714-527-0208

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	10/18/2024

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