Provider Demographics
NPI:1760880827
Name:GARCIA, BERTHA REGINA (LVN)
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:REGINA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11906 RAMONA AVE SPC 27
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1690
Mailing Address - Country:US
Mailing Address - Phone:323-395-4086
Mailing Address - Fax:
Practice Address - Street 1:701 W. CESAR E. CHAVEZ AVE SUITE201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012
Practice Address - Country:US
Practice Address - Phone:213-217-5300
Practice Address - Fax:213-217-5397
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN176769164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse