Provider Demographics
NPI:1952170250
Name:GARCIA, NESTOR JESUS
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:JESUS
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 1:12901 S VERMONT AVE APT F7
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-1623
Mailing Address - Country:US
Mailing Address - Phone:310-617-6070
Mailing Address - Fax:
Practice Address - Street 1:12901 S VERMONT AVE
Practice Address - Street 2:F7
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247
Practice Address - Country:US
Practice Address - Phone:310-617-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF5585828172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver