Provider Demographics
NPI:1750662201
Name:GARCIA, SAMUEL EDUARDO
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:EDUARDO
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 1:935 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4217
Mailing Address - Country:US
Mailing Address - Phone:530-865-5544
Mailing Address - Fax:530-865-9209
Practice Address - Street 1:1211 CORTINA DR
Practice Address - Street 2:
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963-1699
Practice Address - Country:US
Practice Address - Phone:530-865-5544
Practice Address - Fax:530-865-9209
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09872400207Q00000X
CAA163436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty