=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851433916
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ENRIQUE (NMN) GARCIA DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21350 HAWTHORNE BLVD SUITE 155
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90503-5627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-868-9979
-----------------------------------------------------
Fax | 562-868-4761
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1235 S GERTRUDA AVE
-----------------------------------------------------
City | REDONDO BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90277-5125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-543-1938
-----------------------------------------------------
Fax | 310-543-9796
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 30506
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------