Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | C53061 | CA |
NPI | 1598308959 |
---|---|
Provider Name | Ricardo Daniel Garcia |
First Address | San Diego, CA 92103-2229 |
Second Address | San Diego, CA 92103-2229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2019 |
Last Update Date | 17/10/2019 |