Healthcare Provider Details

I. General information

NPI: 1639230105
Provider Name (Legal Business Name): EDGAR GARCIA B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N EUCLID AVENUE SUITE 300
ANAHEIM CA
92653-1547
US

IV. Provider business mailing address

1222 BALLISTA AVE
LA PUENTE CA
91744-1667
US

V. Phone/Fax

Practice location:
  • Phone: 714-871-5646
  • Fax:
Mailing address:
  • Phone: 626-488-6617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: