Healthcare Provider Details

I. General information

NPI: 1467191858
Provider Name (Legal Business Name): ODALYS EUNICE GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date: 08/12/2025
Reactivation Date: 09/15/2025

III. Provider practice location address

555 N PERRIS BLVD BLDG A
PERRIS CA
92571-2811
US

IV. Provider business mailing address

555 N PERRIS BLVD BLDG A
PERRIS CA
92571-2811
US

V. Phone/Fax

Practice location:
  • Phone: 951-436-5300
  • Fax:
Mailing address:
  • Phone: 951-436-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: