Healthcare Provider Details

I. General information

NPI: 1447668918
Provider Name (Legal Business Name): DIANA GARCIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 S ORCHARD AVE
UKIAH CA
95482-5016
US

IV. Provider business mailing address

275 S ORCHARD AVE
UKIAH CA
95482-5016
US

V. Phone/Fax

Practice location:
  • Phone: 707-463-3440
  • Fax: 707-463-3446
Mailing address:
  • Phone: 707-463-3440
  • Fax: 707-463-3446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number51784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: