Healthcare Provider Details

I. General information

NPI: 1003746702
Provider Name (Legal Business Name): PONCIANO GARCIA CPT-1
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 WILSHIRE BLVD STE 500
LOS ANGELES CA
90017-2656
US

IV. Provider business mailing address

835 WILSHIRE BLVD STE 500
LOS ANGELES CA
90017-2656
US

V. Phone/Fax

Practice location:
  • Phone: 213-646-6035
  • Fax:
Mailing address:
  • Phone: 213-646-6035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT-00065409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: