Healthcare Provider Details

I. General information

NPI: 1316287022
Provider Name (Legal Business Name): EDUARDO B GARCIA JR. FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SAN BERNARDINO ROAD SUITE 1100
UPLAND CA
91786-4952
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 909-949-2242
  • Fax: 909-981-5783
Mailing address:
  • Phone: 626-775-3514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: