Provider Demographics
NPI:1174766000
Name:GARCIA, JESSE THOMAS
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:THOMAS
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30009 WESTLAKE DR
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-8016
Mailing Address - Country:US
Mailing Address - Phone:951-445-6753
Mailing Address - Fax:951-572-3507
Practice Address - Street 1:30009 WESTLAKE DR
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-8016
Practice Address - Country:US
Practice Address - Phone:951-445-6753
Practice Address - Fax:951-572-3507
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD1844226172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver