Healthcare Provider Details

I. General information

NPI: 1003955519
Provider Name (Legal Business Name): LUIS OBISPO GARCIA-NIQUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12555 GARDEN GROVE BLVD STE 202
GARDEN GROVE CA
92843-1903
US

IV. Provider business mailing address

12555 GARDEN GROVE BLVD STE 202
GARDEN GROVE CA
92843-1903
US

V. Phone/Fax

Practice location:
  • Phone: 714-394-5767
  • Fax: 714-516-9860
Mailing address:
  • Phone: 714-394-5767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA33647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: