Provider Demographics
NPI:1407403587
Name:GARCIA, RONEILIO SAN DIEGO
Entity Type:Individual
Prefix:MR
First Name:RONEILIO
Middle Name:SAN DIEGO
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 1:2104 W. 242ND STREET
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717
Mailing Address - Country:US
Mailing Address - Phone:424-757-2323
Mailing Address - Fax:
Practice Address - Street 1:2104 W. 242ND STREET
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717
Practice Address - Country:US
Practice Address - Phone:424-757-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider