Healthcare Provider Details

I. General information

NPI: 1750662201
Provider Name (Legal Business Name): SAMUEL EDUARDO GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 CORTINA DR
ORLAND CA
95963-1699
US

IV. Provider business mailing address

935 MARKET ST
YUBA CITY CA
95991-4217
US

V. Phone/Fax

Practice location:
  • Phone: 530-865-5544
  • Fax: 530-865-9209
Mailing address:
  • Phone: 530-865-5544
  • Fax: 530-865-9209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA09872400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA163436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: