Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | SL4939 | CA |
NPI | 1023592292 |
---|---|
Provider Name | Ilian Garcia |
First Address | Salinas, CA 93901-2207 |
Second Address | Salinas, CA 93901-2207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2018 |
Last Update Date | 24/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
83-1621611 | VISION (01) | CA |