Provider Demographics
NPI:1780707646
Name:SANTOS GARCIA
Entity type:Organization
Organization Name:SANTOS GARCIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANTOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-814-3513
Mailing Address - Street 1:3544 LINCOLN AVE
Mailing Address - Street 2:SUITE 2W
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-4045
Mailing Address - Country:US
Mailing Address - Phone:801-814-3513
Mailing Address - Fax:
Practice Address - Street 1:3544 LINCOLN AVE
Practice Address - Street 2:SUITE 2W
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-4045
Practice Address - Country:US
Practice Address - Phone:801-814-3513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-07
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory