Healthcare Provider Details

I. General information

NPI: 1053241604
Provider Name (Legal Business Name): LISA MARIE MUEGA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1598 E ECLIPSE AVE
FRESNO CA
93720-1476
US

IV. Provider business mailing address

1598 E ECLIPSE AVE
FRESNO CA
93720-1476
US

V. Phone/Fax

Practice location:
  • Phone: 559-575-6791
  • Fax:
Mailing address:
  • Phone: 559-575-6791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: