Healthcare Provider Details

I. General information

NPI: 1376234542
Provider Name (Legal Business Name): DAVID GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16940 HIGHWAY 14 STE F
MOJAVE CA
93501-1238
US

IV. Provider business mailing address

PO BOX 2632
LAKE ISABELLA CA
93240-2632
US

V. Phone/Fax

Practice location:
  • Phone: 661-824-5020
  • Fax: 661-824-5026
Mailing address:
  • Phone: 760-379-3412
  • Fax: 603-795-3327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW128142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: