Healthcare Provider Details

I. General information

NPI: 1255257176
Provider Name (Legal Business Name): MARCO ANTONIO GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W TELEGRAPH RD
SANTA PAULA CA
93060-3009
US

IV. Provider business mailing address

811 W TELEGRAPH RD
SANTA PAULA CA
93060-3009
US

V. Phone/Fax

Practice location:
  • Phone: 805-265-4894
  • Fax: 805-856-0343
Mailing address:
  • Phone: 805-265-4894
  • Fax: 805-856-0343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: