Provider Demographics
NPI:1639230105
Name:GARCIA, EDGAR (BA)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 BALLISTA AVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1667
Mailing Address - Country:US
Mailing Address - Phone:626-488-6617
Mailing Address - Fax:
Practice Address - Street 1:505 N EUCLID AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92653-1547
Practice Address - Country:US
Practice Address - Phone:714-871-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner