1285743039 NPI number — DANIEL H & EMILY B GARCIA

Table of content: (NPI 1285743039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285743039 NPI number — DANIEL H & EMILY B GARCIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL H & EMILY B GARCIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EAST VALLEY MEDICAL DIAGNOSTIC CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285743039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7438 S D AVE STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCRETE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98237-9642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-853-8183
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7438 S D AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCRETE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98237-9642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-853-8183
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
EMILY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
ADMINISTRATOR/OWNER
Authorized Official Telephone Number:
360-853-8183

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 33706 . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 18289 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7261100 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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