Healthcare Provider Details

I. General information

NPI: 1952872079
Provider Name (Legal Business Name): DIEGO ARMANDO GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3148 MIDWAY DR
SAN DIEGO CA
92110-4539
US

IV. Provider business mailing address

3148 MIDWAY DR
SAN DIEGO CA
92110-4539
US

V. Phone/Fax

Practice location:
  • Phone: 619-363-0853
  • Fax: 619-362-9905
Mailing address:
  • Phone: 619-363-0853
  • Fax: 619-362-9905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: