Provider Demographics
NPI:1487012811
Name:GARCIA, MICHELLE (APN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25301 CABOT RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5511
Mailing Address - Country:US
Mailing Address - Phone:949-485-4835
Mailing Address - Fax:
Practice Address - Street 1:25301 CABOT RD STE 103
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5511
Practice Address - Country:US
Practice Address - Phone:949-485-4835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-30
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012820363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner