Provider Demographics
NPI:1104978972
Name:GARCIA, GERALD VINUYA (DMD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:VINUYA
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2913
Mailing Address - Street 2:
Mailing Address - City:W COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91793
Mailing Address - Country:US
Mailing Address - Phone:626-338-7092
Mailing Address - Fax:626-338-2313
Practice Address - Street 1:817 S GLENDORA AVE
Practice Address - Street 2:
Practice Address - City:W COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:626-338-7092
Practice Address - Fax:626-338-2313
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48270122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist