1124127659 NPI number — MR. RONALD PAUL GARCIA-HERRERA PA-C

Table of content: MR. RONALD PAUL GARCIA-HERRERA PA-C (NPI 1124127659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124127659 NPI number — MR. RONALD PAUL GARCIA-HERRERA PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA-HERRERA
Provider First Name:
RONALD
Provider Middle Name:
PAUL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HERRERA
Provider Other First Name:
RONALD
Provider Other Middle Name:
PAUL
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1124127659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 ROSSI CIR
Provider Second Line Business Mailing Address:
SUITE 141
Provider Business Mailing Address City Name:
SALINAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93907-2362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-757-4444
Provider Business Mailing Address Fax Number:
831-757-4419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
285 MERCEY SPRINGS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS BANOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93635-3878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-829-0444
Provider Business Practice Location Address Fax Number:
209-829-0445
Provider Enumeration Date:
09/21/2006

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: 363AM0700X , with the licence number:  12100 , 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)





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