Provider Demographics
NPI:1497778260
Name:GARCIA, BRUNO (MD)
Entity Type:Individual
Prefix:
First Name:BRUNO
Middle Name:
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 1:600 N PIEDRA RD
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-9527
Mailing Address - Country:US
Mailing Address - Phone:559-783-1181
Mailing Address - Fax:559-783-2084
Practice Address - Street 1:1041 ROSE AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3240
Practice Address - Country:US
Practice Address - Phone:559-783-1181
Practice Address - Fax:559-783-2084
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A636440Medicaid
G77658Medicare UPIN
CA00A636440Medicaid