Provider Demographics
NPI:1952036725
Name:GARCIA, CARMEN HAYDEE (LVN)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:HAYDEE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10796 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-2610
Mailing Address - Country:US
Mailing Address - Phone:424-230-6448
Mailing Address - Fax:
Practice Address - Street 1:10796 9TH AVE
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-2610
Practice Address - Country:US
Practice Address - Phone:424-230-6448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA719232164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse