Provider Demographics
NPI:1639368079
Name:GARCIA, LEE & CONCEPCION MEDICAL GROUP
Entity Type:Organization
Organization Name:GARCIA, LEE & CONCEPCION MEDICAL GROUP
Other - Org Name:RIVER BEND MEDICAL ASSOCIATES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:OCHOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-392-4000
Mailing Address - Street 1:2101 STONE BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-4044
Mailing Address - Country:US
Mailing Address - Phone:916-371-4393
Mailing Address - Fax:
Practice Address - Street 1:2101 STONE BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-4044
Practice Address - Country:US
Practice Address - Phone:916-371-4393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARCIA, LEE & CONCEPCION MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-22
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ13862ZMedicare PIN