Healthcare Provider Details

I. General information

NPI: 1760736730
Provider Name (Legal Business Name): JOE RUDY GARCIA SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 S WESTERN AVE APT 104
ANAHEIM CA
92804-1641
US

IV. Provider business mailing address

2035 E BALL RD STE 200
ANAHEIM CA
92806-5157
US

V. Phone/Fax

Practice location:
  • Phone: 714-640-1734
  • Fax:
Mailing address:
  • Phone: 714-517-6382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: