Provider Demographics
NPI:1376033761
Name:GARCIA, DAVID R
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
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 1:1751 CLOVERFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-4007
Mailing Address - Country:US
Mailing Address - Phone:310-883-1220
Mailing Address - Fax:310-883-1223
Practice Address - Street 1:1751 CLOVERFIELD BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-883-1220
Practice Address - Fax:310-883-1223
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty