Provider Demographics
NPI:1225810419
Name:GARCIA, ROANLD JASON (DACM)
Entity Type:Individual
Prefix:DR
First Name:ROANLD
Middle Name:JASON
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3631
Mailing Address - Country:US
Mailing Address - Phone:917-657-6795
Mailing Address - Fax:
Practice Address - Street 1:1011 CAMINO DEL RIO S STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3532
Practice Address - Country:US
Practice Address - Phone:619-915-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19848171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist