Provider Demographics
NPI:1073627402
Name:GARCIA, GREGORY PAUL (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PAUL
Last Name:GARCIA
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5547 NE MALLORY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-2519
Mailing Address - Country:US
Mailing Address - Phone:503-804-4797
Mailing Address - Fax:503-289-2897
Practice Address - Street 1:12555 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-0546
Practice Address - Country:US
Practice Address - Phone:503-804-4797
Practice Address - Fax:503-289-2897
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00538171100000X
OR693175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR008099Medicaid