Healthcare Provider Details

I. General information

NPI: 1497307813
Provider Name (Legal Business Name): IVONNE JEANETTE GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 MARKLEIN AVE
NORTH HILLS CA
91343-2131
US

IV. Provider business mailing address

9800 MARKLEIN AVE
NORTH HILLS CA
91343-2131
US

V. Phone/Fax

Practice location:
  • Phone: 818-419-1460
  • Fax:
Mailing address:
  • Phone: 818-419-1460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number646189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: