Healthcare Provider Details

I. General information

NPI: 1275162265
Provider Name (Legal Business Name): ANTONIO GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 10/27/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14350 MERIDIAN PKWY
RIVERSIDE CA
92518-3035
US

IV. Provider business mailing address

14305 MERIDIAN PKWY
RIVERSIDE CA
92518-3034
US

V. Phone/Fax

Practice location:
  • Phone: 951-827-7669
  • Fax:
Mailing address:
  • Phone: 833-574-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number185817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: