Provider Demographics
NPI:1821023284
Name:GARCIA, GUADALUPE MANUEL (DDS)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:MANUEL
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MANUAL
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4429 W NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291
Mailing Address - Country:US
Mailing Address - Phone:559-625-1380
Mailing Address - Fax:559-627-5000
Practice Address - Street 1:3000 W CECIL AVE
Practice Address - Street 2:KERN VALLEY STATE PRISON
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93216-6000
Practice Address - Country:US
Practice Address - Phone:661-721-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24017122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist