MEDICARE: DR. JOSE LUIS GARCIA 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	208D00000X	General Practice Physician	A48538	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	:	1053360362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE LUIS GARCIA M.D.

Provider Business Mailing Address
First Line	:	711 W COLLEGE ST
Second Line	:	628
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-1163
Country	:	US
Telephone Number	:	213-830-8920
Fax Number	:	213-830-8925

Provider Business Practice Location Address
First Line	:	4837 HUNTINGTON DR N
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90032-1953
Country	:	US
Telephone Number	:	323-343-9460
Fax Number	:	323-343-9466

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

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	09/10/2007

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