Healthcare Provider Details

I. General information

NPI: 1528849981
Provider Name (Legal Business Name): SAMUEL J GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 SURFWOOD LN
SAN DIEGO CA
92154-8467
US

IV. Provider business mailing address

1221 SURFWOOD LN
SAN DIEGO CA
92154-8467
US

V. Phone/Fax

Practice location:
  • Phone: 619-253-0244
  • Fax:
Mailing address:
  • Phone: 619-253-0244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number331184
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: