Healthcare Provider Details

I. General information

NPI: 1497249502
Provider Name (Legal Business Name): NICHOLAS GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 GATEWAY BLVD FL 2
SOUTH SAN FRANCISCO CA
94080-7401
US

IV. Provider business mailing address

801 GATEWAY BLVD FL 2
SOUTH SAN FRANCISCO CA
94080-7401
US

V. Phone/Fax

Practice location:
  • Phone: 650-454-6377
  • Fax:
Mailing address:
  • Phone: 650-454-6377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: