Provider Demographics
NPI:1275790693
Name:GARCIA, ELPIDIO PETE
Entity Type:Individual
Prefix:
First Name:ELPIDIO
Middle Name:PETE
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 1:1100 VAN NESS AVE
Mailing Address - Street 2:#804
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-2016
Mailing Address - Country:US
Mailing Address - Phone:559-488-3420
Mailing Address - Fax:559-262-4339
Practice Address - Street 1:1100 VAN NESS AVE
Practice Address - Street 2:#804
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-2016
Practice Address - Country:US
Practice Address - Phone:559-488-3420
Practice Address - Fax:559-262-4339
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management