Healthcare Provider Details

I. General information

NPI: 1710802244
Provider Name (Legal Business Name): CARLOS FERNANDO GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 SAN PABLO DAM RD
EL SOBRANTE CA
94803-2729
US

IV. Provider business mailing address

2520 RYAN RD APT 19
CONCORD CA
94518-2601
US

V. Phone/Fax

Practice location:
  • Phone: 510-816-7771
  • Fax:
Mailing address:
  • Phone: 510-816-7771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: