Provider Demographics
NPI:1881813228
Name:GARCIA, MARISTELA B (MD)
Entity type:Individual
Prefix:DR
First Name:MARISTELA
Middle Name:B
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARISTELA
Other - Middle Name:B
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 292463
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-8463
Mailing Address - Country:US
Mailing Address - Phone:626-354-0267
Mailing Address - Fax:
Practice Address - Street 1:10945 LE CONTE AVE
Practice Address - Street 2:DIVISION OF GERIATRICS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3000
Practice Address - Country:US
Practice Address - Phone:310-825-8253
Practice Address - Fax:310-794-2113
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52252207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2061923Medicaid
OHG76427Medicare UPIN
OH2061923Medicaid
CABY035ZMedicare PIN