Provider Demographics
NPI:1467175919
Name:GARCIA, DEYSE
Entity Type:Individual
Prefix:
First Name:DEYSE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2497 HERNDON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-8977
Mailing Address - Country:US
Mailing Address - Phone:559-900-7133
Mailing Address - Fax:559-899-2619
Practice Address - Street 1:2497 HERNDON AVE STE 104
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-8977
Practice Address - Country:US
Practice Address - Phone:559-900-7133
Practice Address - Fax:559-899-2619
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental