Healthcare Provider Details

I. General information

NPI: 1316245079
Provider Name (Legal Business Name): SAMANTHA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 GLENDALE AV
OXNARD CA
93035
US

IV. Provider business mailing address

124 GLENDALE AVE
OXNARD CA
93035-4511
US

V. Phone/Fax

Practice location:
  • Phone: 626-975-4745
  • Fax:
Mailing address:
  • Phone: 626-975-4745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number6596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: