Provider Demographics
NPI:1821169087
Name:GARCIA, JEFFERY M (PAC)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:M
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PAC
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:414 N CAMDEN DRIVE
Mailing Address - Street 2:STE 1100 CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIF
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4532
Mailing Address - Country:US
Mailing Address - Phone:310-278-3400
Mailing Address - Fax:310-278-1240
Practice Address - Street 1:414 N CAMDEN DRIVE
Practice Address - Street 2:STE 1100 CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIF
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4532
Practice Address - Country:US
Practice Address - Phone:310-278-3400
Practice Address - Fax:310-278-1240
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA17219363AM0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA17219AMedicare PIN