Provider Demographics
NPI:1235712555
Name:GARCIA, ALEXIS
Entity Type:Individual
Prefix:MR
First Name:ALEXIS
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10343 SAN DIEGO MISSION RD APT D333
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2170
Mailing Address - Country:US
Mailing Address - Phone:815-979-8167
Mailing Address - Fax:
Practice Address - Street 1:10343 SAN DIEGO MISSION RD APT D333
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2170
Practice Address - Country:US
Practice Address - Phone:815-979-8167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program