Provider Demographics
NPI:1043923469
Name:GARCIA, ENID (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ENID
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:ENID
Other - Middle Name:B
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1800 WESTERN AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1355
Mailing Address - Country:US
Mailing Address - Phone:909-880-3677
Mailing Address - Fax:
Practice Address - Street 1:1800 WESTERN AVE STE 401
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1355
Practice Address - Country:US
Practice Address - Phone:909-880-3677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-30
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA746196163WG0000X
CA95024937363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice