Provider Demographics
NPI:1407934086
Name:GARCIA, ROSALVA M (DDS)
Entity Type:Individual
Prefix:MS
First Name:ROSALVA
Middle Name:M
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2128
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-0128
Mailing Address - Country:US
Mailing Address - Phone:714-541-0891
Mailing Address - Fax:714-541-0894
Practice Address - Street 1:1614 FRENCH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2419
Practice Address - Country:US
Practice Address - Phone:714-541-0891
Practice Address - Fax:714-541-0894
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB37108-02OtherDENTICAL