Healthcare Provider Details

I. General information

NPI: 1053230128
Provider Name (Legal Business Name): MIGUEL A GARCIA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 EDMONDS RD
REDWOOD CITY CA
94062-3813
US

IV. Provider business mailing address

1667 KIMIYO ST
STOCKTON CA
95206-5640
US

V. Phone/Fax

Practice location:
  • Phone: 650-374-2005
  • Fax:
Mailing address:
  • Phone: 650-374-2005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number752124
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: