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General NPI Number Information
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NPI Number | 1023440773
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Entity Type | Organization
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Legal Business Name | LTB MEDICAL GROUP
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Dates
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Enumeration Date | 08/05/2013
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Last Update Date | 08/05/2013
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Provider Practice Location Address
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Address Line | 2141 HIGH ST
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City | SELMA
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State | CA
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Zip | 93662-3065
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Country | US
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Telephone | 559-891-2611
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Fax | 559-891-3118
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Provider Business Mailing Address
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Address Line | 600 N PIEDRA RD
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City | SANGER
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State | CA
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Zip | 93657-9527
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Country | US
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Telephone | 559-787-3470
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRUNO GARCIA
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Credential | MD
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Telephone | 559-787-3470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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