Healthcare Provider Details

I. General information

NPI: 1497778260
Provider Name (Legal Business Name): BRUNO GARCIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 ROSE AVE
SELMA CA
93662-3240
US

IV. Provider business mailing address

600 N PIEDRA RD
SANGER CA
93657-9527
US

V. Phone/Fax

Practice location:
  • Phone: 559-783-1181
  • Fax: 559-783-2084
Mailing address:
  • Phone: 559-783-1181
  • Fax: 559-783-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA63644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: