Provider Demographics
NPI:1205496239
Name:GARCIA RICARDO, WILMER ERNESTO (MD)
Entity type:Individual
Prefix:
First Name:WILMER
Middle Name:ERNESTO
Last Name:GARCIA RICARDO
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 1:8083 MARINERS DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-5428
Mailing Address - Country:US
Mailing Address - Phone:786-296-6446
Mailing Address - Fax:
Practice Address - Street 1:8083 MARINERS DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-5428
Practice Address - Country:US
Practice Address - Phone:786-296-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA176543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine