Provider Demographics
NPI:1932143195
Name:GARCIA, CARLOS BENJAMIN (PA)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:BENJAMIN
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14359 PIONEER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4850
Mailing Address - Country:US
Mailing Address - Phone:562-864-7279
Mailing Address - Fax:562-406-8606
Practice Address - Street 1:14359 PIONEER BLVD STE A
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4850
Practice Address - Country:US
Practice Address - Phone:562-864-7279
Practice Address - Fax:562-406-8606
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13910363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA13910OtherPA LICENSE NUMBER