Provider Demographics
NPI:1952396392
Name:GARCIA, MICHELLE NIEVES (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:NIEVES
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:N
Other - Last Name:GARCIA REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:3838 SHERMAN DR
Mailing Address - Street 2:SUITE # 203
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-4001
Mailing Address - Country:US
Mailing Address - Phone:951-785-6767
Mailing Address - Fax:951-785-6783
Practice Address - Street 1:3838 SHERMAN DR
Practice Address - Street 2:SUITE # 203
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4001
Practice Address - Country:US
Practice Address - Phone:951-785-6767
Practice Address - Fax:951-785-6783
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16053363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant