Provider Demographics
NPI:1104101401
Name:GARCIA, LUIS E (PA)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:E
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:208 CONCOURSE BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-8210
Mailing Address - Country:US
Mailing Address - Phone:707-544-3400
Mailing Address - Fax:707-544-0137
Practice Address - Street 1:208 CONCOURSE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-8210
Practice Address - Country:US
Practice Address - Phone:707-544-3400
Practice Address - Fax:707-544-0137
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA21935363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical