=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649646647
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. ALBERT GARCIA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2015
-----------------------------------------------------
Last Update Date | 08/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5588 N PALM AVE SUITE P-4
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93704-1913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-349-9588
-----------------------------------------------------
Fax | 559-650-5590
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5588 N PALM AVE SUITE P-4
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93704-1913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-349-9588
-----------------------------------------------------
Fax | 559-650-5590
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | F4258682
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------