Healthcare Provider Details

I. General information

NPI: 1548590995
Provider Name (Legal Business Name): MARIO EUDAVE GARCIA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 ARLINGTON AVE STE. E
RIVERSIDE CA
92504-1924
US

IV. Provider business mailing address

6611 ARLINGTON AVE SUITE E
RIVERSIDE CA
92504-1924
US

V. Phone/Fax

Practice location:
  • Phone: 909-647-5811
  • Fax: 951-359-1229
Mailing address:
  • Phone: 909-647-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number31070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: