Healthcare Provider Details

I. General information

NPI: 1881813228
Provider Name (Legal Business Name): MARISTELA B GARCIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARISTELA B GARCIA MD

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10945 LE CONTE AVE DIVISION OF GERIATRICS
LOS ANGELES CA
90095-3000
US

IV. Provider business mailing address

PO BOX 292463
LOS ANGELES CA
90029-8463
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-8253
  • Fax: 310-794-2113
Mailing address:
  • Phone: 626-354-0267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberC52252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: