Provider Demographics
NPI:1417959370
Name:GARCIA, CARLOS MARCELINO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:MARCELINO
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1392 E PALOMAR ST STE 501
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1895
Mailing Address - Country:US
Mailing Address - Phone:619-271-4059
Mailing Address - Fax:619-271-7451
Practice Address - Street 1:1392 E PALOMAR ST STE 501
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-1895
Practice Address - Country:US
Practice Address - Phone:619-271-4059
Practice Address - Fax:619-271-7451
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42509208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42509Medicaid
CAA42509Medicaid
0228834Medicare PIN