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General NPI Number Information
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NPI Number | 1871572628
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Entity Type | Individual
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Provider Name | FRED GARCIA II M.D.,PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 360 E OLIVE AVE
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City | BURBANK
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State | CA
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Zip | 91502-1215
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Country | US
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Telephone | 800-700-8774
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Fax | 818-954-0096
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Provider Business Mailing Address
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Address Line | 2510 W SILVER LAKE DR
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City | LOS ANGELES
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State | CA
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Zip | 90039-3169
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Country | US
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Telephone | 323-665-9018
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Fax | 323-663-0355
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A24259
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License Number State | CA
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