Healthcare Provider Details

I. General information

NPI: 1134052681
Provider Name (Legal Business Name): JOHNNY GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31772 CASINO DR STE B
LAKE ELSINORE CA
92530-4502
US

IV. Provider business mailing address

31772 CASINO DR STE B
LAKE ELSINORE CA
92530-4502
US

V. Phone/Fax

Practice location:
  • Phone: 951-674-9400
  • Fax:
Mailing address:
  • Phone: 951-670-8655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: