Provider Demographics
NPI:1821177833
Name:GARCIA, ANTONIO M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:M
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 1:586 E MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1938
Mailing Address - Country:US
Mailing Address - Phone:909-622-6240
Mailing Address - Fax:909-629-5736
Practice Address - Street 1:586 E MISSION BLVD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766
Practice Address - Country:US
Practice Address - Phone:909-622-6240
Practice Address - Fax:909-629-5736
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49168207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49168Medicaid
G47742Medicare UPIN
CAA49168Medicaid