Healthcare Provider Details

I. General information

NPI: 1023592292
Provider Name (Legal Business Name): ILIAN GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 S MAIN ST
SALINAS CA
93901-2207
US

IV. Provider business mailing address

843 COLUMBIA AVE
SALINAS CA
93901-2207
US

V. Phone/Fax

Practice location:
  • Phone: 831-424-1242
  • Fax:
Mailing address:
  • Phone: 831-402-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberSL4939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: