Provider Demographics
NPI:1629064811
Name:GARCIA, RICARDO (DC)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 S ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-5012
Mailing Address - Country:US
Mailing Address - Phone:323-780-1838
Mailing Address - Fax:323-780-7823
Practice Address - Street 1:1260 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-5012
Practice Address - Country:US
Practice Address - Phone:323-780-1838
Practice Address - Fax:323-780-7823
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
CADC 20592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU02318Medicare UPIN
CADC20592Medicare ID - Type Unspecified