Healthcare Provider Details

I. General information

NPI: 1982974176
Provider Name (Legal Business Name): MR. ROBERTO GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43520 DIVISION ST
LANCASTER CA
93535-4089
US

IV. Provider business mailing address

43520 DIVISION ST
LANCASTER CA
93535-4089
US

V. Phone/Fax

Practice location:
  • Phone: 661-274-0770
  • Fax: 661-274-9970
Mailing address:
  • Phone: 661-274-0770
  • Fax: 661-274-9970

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: