Healthcare Provider Details

I. General information

NPI: 1861940355
Provider Name (Legal Business Name): CARLOS GARCIA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10445 MAST BLVD # 11
SANTEE CA
92071
US

IV. Provider business mailing address

10445 MAST BVD # 11
SANTEE CA
92071
US

V. Phone/Fax

Practice location:
  • Phone: 619-822-8943
  • Fax:
Mailing address:
  • Phone: 619-822-8943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: