Provider Demographics
NPI:1184703043
Name:GARCIA, LUIS HUMBERTO (PA)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:HUMBERTO
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1996 N D ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-3912
Mailing Address - Country:US
Mailing Address - Phone:909-883-7777
Mailing Address - Fax:909-883-7773
Practice Address - Street 1:1996 N D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-3912
Practice Address - Country:US
Practice Address - Phone:909-883-7777
Practice Address - Fax:909-883-7773
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17048363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant