Provider Demographics
NPI:1437145505
Name:GARCIA, NICOLE A (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6200 E.CANYON RIM RD
Mailing Address - Street 2:SUITE 105B
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807
Mailing Address - Country:US
Mailing Address - Phone:714-998-3627
Mailing Address - Fax:714-998-1895
Practice Address - Street 1:6200 E. CANYON RIM RD
Practice Address - Street 2:SUITE 105B
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807
Practice Address - Country:US
Practice Address - Phone:714-998-3627
Practice Address - Fax:714-998-1895
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA62657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG41384Medicare UPIN