Healthcare Provider Details

I. General information

NPI: 1356712020
Provider Name (Legal Business Name): OSCAR RENE GARCIA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 BURNHAM AVE STE 270
LAS VEGAS NV
89119-8205
US

IV. Provider business mailing address

2370 CORPORATE CIR STE 300
HENDERSON NV
89074-7760
US

V. Phone/Fax

Practice location:
  • Phone: 702-888-3221
  • Fax: 702-888-3187
Mailing address:
  • Phone: 702-910-3950
  • Fax: 702-778-2264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2017
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: