Provider Demographics
NPI:1740652593
Name:GARCIA, ERICK ERNESTO
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:ERNESTO
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6372 LOS ROBLES AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3055
Mailing Address - Country:US
Mailing Address - Phone:951-264-5691
Mailing Address - Fax:
Practice Address - Street 1:6372 LOS ROBLES AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3055
Practice Address - Country:US
Practice Address - Phone:951-264-5691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74992126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant