Healthcare Provider Details

I. General information

NPI: 1679538268
Provider Name (Legal Business Name): CHRISTOPHER DANIEL GARCIA INDEPENDENT DUTY COR
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CLR 17 RAS
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

1818 THIBODO RD
VISTA CA
92081-7583
US

V. Phone/Fax

Practice location:
  • Phone: 760-763-6239
  • Fax:
Mailing address:
  • Phone: 619-847-4472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: