Healthcare Provider Details

I. General information

NPI: 1184984759
Provider Name (Legal Business Name): RYAN L GARCIA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOAG DR
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

PO BOX 8279
FREMONT CA
94537-8279
US

V. Phone/Fax

Practice location:
  • Phone: 510-952-7229
  • Fax:
Mailing address:
  • Phone: 510-952-7229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22257
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: