Provider Demographics
NPI:1225253933
Name:GARCIA, REGINO LAZO (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINO
Middle Name:LAZO
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:COVELO
Mailing Address - State:CA
Mailing Address - Zip Code:95428-0247
Mailing Address - Country:US
Mailing Address - Phone:707-983-6404
Mailing Address - Fax:707-983-6184
Practice Address - Street 1:HIGHWAY 162 & BIGGAR LANE
Practice Address - Street 2:
Practice Address - City:COVELO
Practice Address - State:CA
Practice Address - Zip Code:95428-0247
Practice Address - Country:US
Practice Address - Phone:707-983-6404
Practice Address - Fax:707-983-6184
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATHP11697FMedicaid
CAD49410Medicare UPIN
CATHP11697FMedicaid