Provider Demographics
NPI:1871501288
Name:GARCIA, SERAFIN MONTEALTO (MD)
Entity Type:Individual
Prefix:
First Name:SERAFIN
Middle Name:MONTEALTO
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 1:1560 E CHEVY CHASE DR
Mailing Address - Street 2:SUITE 450
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4197
Mailing Address - Country:US
Mailing Address - Phone:818-242-4966
Mailing Address - Fax:818-241-0248
Practice Address - Street 1:1560 E CHEVY CHASE DR
Practice Address - Street 2:SUITE 450
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4197
Practice Address - Country:US
Practice Address - Phone:818-242-4966
Practice Address - Fax:818-241-0248
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26819207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G268190Medicaid
CAG26819Medicare PIN
CAA89439Medicare UPIN