=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710403183
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXCELCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2017
-----------------------------------------------------
Last Update Date | 08/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2400 CHESTER AVE
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93301-4020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-212-2298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15701 TRADITION CT
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93314-7874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-212-2298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RALPH GARCIA-PACHECO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 313-212-2298
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | A110188
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------