Provider Demographics
NPI:1841219243
Name:GARCIA, TERESA H (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:H
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 W LA VETA AVE STE 560
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4214
Mailing Address - Country:US
Mailing Address - Phone:714-547-8700
Mailing Address - Fax:714-547-2460
Practice Address - Street 1:1140 W LA VETA AVE STE 560
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4214
Practice Address - Country:US
Practice Address - Phone:714-547-8700
Practice Address - Fax:714-547-2460
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71922174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG71922OtherSTATE LICENSE
CAGR0087980Medicaid
CA33-0912975OtherTAX IDENTIFIER
CA00G719223Medicaid
CAW14962Medicare ID - Type UnspecifiedGROUP ID
CA33-0912975OtherTAX IDENTIFIER
CAG71922OtherSTATE LICENSE