Provider Demographics
NPI:1821508003
Name:GARCIA, EDGAR OMAR
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:OMAR
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 E H ST APT 706
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7468
Mailing Address - Country:US
Mailing Address - Phone:210-202-9604
Mailing Address - Fax:
Practice Address - Street 1:454 E H ST APT 706
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7468
Practice Address - Country:US
Practice Address - Phone:210-202-9604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman