Healthcare Provider Details

I. General information

NPI: 1598308959
Provider Name (Legal Business Name): RICARDO DANIEL GARCIA ORTHOTIC FITTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 WASHINGTON ST STE 400
SAN DIEGO CA
92103-2229
US

IV. Provider business mailing address

550 WASHINGTON ST STE 400
SAN DIEGO CA
92103-2229
US

V. Phone/Fax

Practice location:
  • Phone: 619-291-8122
  • Fax: 619-291-8446
Mailing address:
  • Phone: 619-291-8122
  • Fax: 619-291-8446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberC53061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: