Healthcare Provider Details

I. General information

NPI: 1407809288
Provider Name (Legal Business Name): JUAN CARLOS GARCIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST DIVISION OF GASTROENTEROLOGY
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

4150 V ST DIVISION OF GASTROENTEROLOGY
SACRAMENTO CA
95817-1460
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3751
  • Fax: 916-734-7908
Mailing address:
  • Phone: 916-734-3751
  • Fax: 916-734-7908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA64A10
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: