Provider Demographics
NPI:1265917207
Name:GARCIA, RENE ISSAC JR (LVN)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:ISSAC
Last Name:GARCIA
Suffix:JR
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1018
Mailing Address - Country:US
Mailing Address - Phone:619-328-8030
Mailing Address - Fax:
Practice Address - Street 1:843 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1018
Practice Address - Country:US
Practice Address - Phone:619-328-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN292796164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse