Provider Demographics
NPI:1003965542
Name:GARCIA DE ALBA, RUBEN (PA-C)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:GARCIA DE ALBA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 14545
Mailing Address - Street 2:P.O. BOX 14545
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501
Mailing Address - Country:US
Mailing Address - Phone:323-908-4200
Mailing Address - Fax:323-908-4262
Practice Address - Street 1:4425 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-3629
Practice Address - Country:US
Practice Address - Phone:323-908-4200
Practice Address - Fax:323-908-4262
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA-15262363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant