Healthcare Provider Details

I. General information

NPI: 1194109454
Provider Name (Legal Business Name): SAUL GARCIA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 N HIGHLAND AVE
AURORA IL
60506-1449
US

IV. Provider business mailing address

1304 N BENGAL RD
METAIRIE LA
70003-5816
US

V. Phone/Fax

Practice location:
  • Phone: 630-801-5700
  • Fax:
Mailing address:
  • Phone: 504-931-9995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number300317
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085005542
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: