Provider Demographics
NPI:1073052882
Name:GARCIA, PATRICIA MAE (RDN)
Entity Type:Individual
Prefix:
First Name:PATRICIA MAE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 REGULO PL APT 1621
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7764
Mailing Address - Country:US
Mailing Address - Phone:619-623-3692
Mailing Address - Fax:
Practice Address - Street 1:630 BAY BLVD
Practice Address - Street 2:101
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5262
Practice Address - Country:US
Practice Address - Phone:619-420-6725
Practice Address - Fax:619-420-6736
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86020535133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered