Healthcare Provider Details

I. General information

NPI: 1932748324
Provider Name (Legal Business Name): ALEC RYAN GARCIA RT(MR)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24331 EL TORO RD
LAGUNA WOODS CA
92637-2752
US

IV. Provider business mailing address

24331 EL TORO RD
LAGUNA WOODS CA
92637-2752
US

V. Phone/Fax

Practice location:
  • Phone: 949-586-3200
  • Fax:
Mailing address:
  • Phone: 949-586-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License Number574946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: