Provider Demographics
NPI:1164453353
Name:GARCIA, JOHN EVERETT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EVERETT
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:ONE GRAND AVE
Mailing Address - Street 2:CALIFORNIA POLYTECHNIC UNIVERSITY
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93407-0210
Mailing Address - Country:US
Mailing Address - Phone:805-756-5373
Mailing Address - Fax:805-756-5298
Practice Address - Street 1:1 GRAND AVE
Practice Address - Street 2:CALIFORNIA POLYTECHNIC UNIVERSITY
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93407-9000
Practice Address - Country:US
Practice Address - Phone:805-756-5373
Practice Address - Fax:805-756-5298
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57975207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G579750Medicaid
CAWG57975EMedicare PIN
CAWG57975DMedicare PIN
CA00G579750Medicaid