Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 9673T | CA |
NPI | 1003968199 |
---|---|
Provider Name | Dr. Ronald Santiago Garcia |
First Address | San Rafael, CA 94901-2812 |
Second Address | San Rafael, CA 94901-2812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 26/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U49757 | (02) | CA |