Healthcare Provider Details

I. General information

NPI: 1053094193
Provider Name (Legal Business Name): LUIS ANTONIO GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8337 TELEGRAPH RD STE 119
PICO RIVERA CA
90660-4941
US

IV. Provider business mailing address

8337 TELEGRAPH RD STE 119
PICO RIVERA CA
90660-4941
US

V. Phone/Fax

Practice location:
  • Phone: 562-776-3444
  • Fax: 562-776-3441
Mailing address:
  • Phone: 562-776-3444
  • Fax: 562-776-3441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95026519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: