Healthcare Provider Details

I. General information

NPI: 1184455701
Provider Name (Legal Business Name): MARIO ALEXANDER GARCIA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3413 W PACIFIC AVE STE 200
BURBANK CA
91505-1598
US

IV. Provider business mailing address

2528 CARLOS ST
ALHAMBRA CA
91803-4313
US

V. Phone/Fax

Practice location:
  • Phone: 818-841-3936
  • Fax:
Mailing address:
  • Phone: 626-213-9647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number306533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: