Provider Demographics
NPI:1457964504
Name:DAVID, MARICHU GARCIA
Entity type:Individual
Prefix:
First Name:MARICHU
Middle Name:GARCIA
Last Name:DAVID
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 1:1368 WALDEN DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-8467
Mailing Address - Country:US
Mailing Address - Phone:916-586-9743
Mailing Address - Fax:
Practice Address - Street 1:89 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-6315
Practice Address - Country:US
Practice Address - Phone:916-543-1583
Practice Address - Fax:877-466-7829
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA852565363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily