Provider Demographics
NPI:1558601492
Name:NICOLE GARCIA MEDICAL, PC
Entity Type:Organization
Organization Name:NICOLE GARCIA MEDICAL, PC
Other - Org Name:YORBA LINDA SUPERIOR PHYSICAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:SHAEVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-692-7139
Mailing Address - Street 1:22224 LA PALMA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3819
Mailing Address - Country:US
Mailing Address - Phone:714-692-7139
Mailing Address - Fax:714-696-7766
Practice Address - Street 1:22224 LA PALMA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-3819
Practice Address - Country:US
Practice Address - Phone:714-692-7139
Practice Address - Fax:714-696-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA062657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty