Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | A143665 | CA |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | A143665 | CA |
NPI | 1548520133 |
---|---|
Provider Name | Bobby Allen Garcia |
First Address | Riverside, CA 92508-5077 |
Second Address | Riverside, CA 92508-5077 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2012 |
Last Update Date | 13/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RS2015-0879 | UNIVERSITY OF NEW MEXICO TRAINING LICENSE (01) | NM |