Provider Demographics
NPI:1164648457
Name:GARCIA, ARIEL (MD)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:
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 1:22807 BARTON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5208
Mailing Address - Country:US
Mailing Address - Phone:909-783-2773
Mailing Address - Fax:909-783-6625
Practice Address - Street 1:22807 BARTON RD
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5208
Practice Address - Country:US
Practice Address - Phone:909-783-2773
Practice Address - Fax:909-783-6625
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50691208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice