Healthcare Provider Details

I. General information

NPI: 1043923469
Provider Name (Legal Business Name): ENID GARCIA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ENID B MORALES RN

II. Dates (important events)

Enumeration Date: 12/30/2022
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 WESTERN AVE STE 401
SAN BERNARDINO CA
92411-1355
US

IV. Provider business mailing address

1800 WESTERN AVE STE 401
SAN BERNARDINO CA
92411-1355
US

V. Phone/Fax

Practice location:
  • Phone: 909-880-3677
  • Fax:
Mailing address:
  • Phone: 909-880-3677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024937
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number746196
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: