Healthcare Provider Details

I. General information

NPI: 1104439900
Provider Name (Legal Business Name): MONICA ALEJANDRA GARCIA ARZOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 09/16/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3148 MIDWAY DR
SAN DIEGO CA
92110-4539
US

IV. Provider business mailing address

8910 CLAIREMONT MESA BLVD
SAN DIEGO CA
92123-1104
US

V. Phone/Fax

Practice location:
  • Phone: 619-363-0853
  • Fax:
Mailing address:
  • Phone: 858-514-5144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246YR1600X
TaxonomyRegistered Record Administrator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: