Provider Demographics
NPI:1073619805
Name:GARCIA, RODOLFO M (MD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:M
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-3450
Mailing Address - Country:US
Mailing Address - Phone:209-710-4124
Mailing Address - Fax:209-710-4131
Practice Address - Street 1:808 IOWA AVE
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635
Practice Address - Country:US
Practice Address - Phone:209-710-4124
Practice Address - Fax:209-710-4131
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine