Provider Demographics
NPI:1942986450
Name:GARCIA, MARTHA ALICIA
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ALICIA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 KINGSLEY AVE APT H11
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95203-1078
Mailing Address - Country:US
Mailing Address - Phone:209-715-8051
Mailing Address - Fax:
Practice Address - Street 1:1339 KINGSLEY AVE APT H11
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203-1078
Practice Address - Country:US
Practice Address - Phone:209-715-8051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X, 376J00000X
CA374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
No376J00000XNursing Service Related ProvidersHomemaker