Provider Demographics
NPI:1790789022
Name:GARCIA, RUEL TAN (MD)
Entity Type:Individual
Prefix:
First Name:RUEL
Middle Name:TAN
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 MONTPELIER DR
Mailing Address - Street 2:STE A
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1622
Mailing Address - Country:US
Mailing Address - Phone:408-347-9001
Mailing Address - Fax:408-347-9004
Practice Address - Street 1:2340 MONTPELIER DR
Practice Address - Street 2:STE A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1622
Practice Address - Country:US
Practice Address - Phone:408-347-9001
Practice Address - Fax:408-347-9004
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79067207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G79067Medicaid
CAG30013Medicare UPIN
CA00G79067Medicare ID - Type Unspecified