1437273687 NPI number — DR. PETER LEANDRO GARCIA MD

Table of content: DR. PETER LEANDRO GARCIA MD (NPI 1437273687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437273687 NPI number — DR. PETER LEANDRO GARCIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA
Provider First Name:
PETER
Provider Middle Name:
LEANDRO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1437273687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 WEST BUNNY AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA MARIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93458-2805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-739-3968
Provider Business Mailing Address Fax Number:
805-922-6101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 SOUTH PALISADE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SANTA MARIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93454-8905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-739-3968
Provider Business Practice Location Address Fax Number:
805-922-6101
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  112173 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CB244946 . This is a "MEDICARE ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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