Healthcare Provider Details

I. General information

NPI: 1144968942
Provider Name (Legal Business Name): JUAN MANUEL GARCIA M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1788 CELESTE AVE
CLOVIS CA
93611-2069
US

IV. Provider business mailing address

1515 WELTY AVE
FIREBAUGH CA
93622-9786
US

V. Phone/Fax

Practice location:
  • Phone: 559-630-9521
  • Fax:
Mailing address:
  • Phone: 559-630-9521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: