Provider Demographics
NPI:1760889687
Name:GARCIA, DIEGO I
Entity Type:Individual
Prefix:MR
First Name:DIEGO
Middle Name:
Last Name:GARCIA
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DIEGO
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSFA
Mailing Address - Street 1:113 PISCIS CT
Mailing Address - Street 2:
Mailing Address - City:RIO RICO
Mailing Address - State:AZ
Mailing Address - Zip Code:85648-2411
Mailing Address - Country:US
Mailing Address - Phone:520-988-2665
Mailing Address - Fax:888-329-6432
Practice Address - Street 1:113 PISCIS CT
Practice Address - Street 2:
Practice Address - City:RIO RICO
Practice Address - State:AZ
Practice Address - Zip Code:85648-2411
Practice Address - Country:US
Practice Address - Phone:520-988-2665
Practice Address - Fax:888-329-6432
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
143973OtherCSFA CERT#