Provider Demographics
NPI:1205832763
Name:GARCIA, PETER JOHN (FNP)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOHN
Last Name:GARCIA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7014 N WHITNEY AVE
Mailing Address - Street 2:STE A
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0155
Mailing Address - Country:US
Mailing Address - Phone:559-321-2858
Mailing Address - Fax:559-321-2780
Practice Address - Street 1:7014 N WHITNEY AVE
Practice Address - Street 2:STE A
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0155
Practice Address - Country:US
Practice Address - Phone:559-321-2858
Practice Address - Fax:559-321-2780
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529858/12683363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA529858OtherRN LICENSE
CANP12683OtherNP LICENSE
CA529858OtherRN LICENSE
CAZZZ23400ZMedicare ID - Type Unspecified