Healthcare Provider Details

I. General information

NPI: 1801346069
Provider Name (Legal Business Name): MARIA ANTONIA GARCIA PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 N CHESTNUT AVE SUITE 102
FRESNO CA
93720-0357
US

IV. Provider business mailing address

5756 W EVERETT AVE
FRESNO CA
93722-2267
US

V. Phone/Fax

Practice location:
  • Phone: 559-437-9024
  • Fax:
Mailing address:
  • Phone: 559-360-4270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number584996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: