Provider Demographics
NPI:1568656262
Name:GARCIA, MIGUEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16980 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3569
Mailing Address - Country:US
Mailing Address - Phone:909-434-0808
Mailing Address - Fax:909-434-0616
Practice Address - Street 1:16980 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3569
Practice Address - Country:US
Practice Address - Phone:909-434-0808
Practice Address - Fax:909-434-0616
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18265363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant