Provider Demographics
NPI:1679791578
Name:GARCIA, DIANA GARZA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:GARZA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6917
Mailing Address - Country:US
Mailing Address - Phone:805-739-3890
Mailing Address - Fax:805-347-7697
Practice Address - Street 1:117 WEST BUNNY AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-2805
Practice Address - Country:US
Practice Address - Phone:805-739-3890
Practice Address - Fax:805-347-7697
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70593FMedicaid
CACB241378OtherMEDICARE ID
CABCP70477FOtherBCP
CAFHC70477FMedicaid
CAHAP70477FOtherFAMILY PACT
CA551903Medicare Oscar/Certification
CAW1508AMedicare PIN
CAW1508Medicare PIN
CAAP501YMedicare PIN
CAHAP70477FOtherFAMILY PACT
CAFHC70477FMedicaid