MEDICARE: JUAN M GARCIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion	306005334	CA

General Provider Information

NPI Number	:	1164297024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN M GARCIA

Provider Business Mailing Address
First Line	:	24301 BARK ST
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-5228
Country	:	US
Telephone Number	:	949-200-2956
Fax Number	:	949-297-3559

Provider Business Practice Location Address
First Line	:	24301 BARK ST
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-5228
Country	:	US
Telephone Number	:	949-200-2956
Fax Number	:	949-297-3559

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2023
Last Update Date	:	11/21/2023

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