Healthcare Provider Details

I. General information

NPI: 1891931150
Provider Name (Legal Business Name): LIZETT VANESSA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2008
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W SHAW AVE STE 110
CLOVIS CA
93612-3684
US

IV. Provider business mailing address

1365 HUNTSMAN AVE
SELMA CA
93662-2556
US

V. Phone/Fax

Practice location:
  • Phone: 559-325-6161
  • Fax:
Mailing address:
  • Phone: 559-579-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: