Provider Demographics
NPI:1487740619
Name:GARCIA, GORETTI (MD)
Entity type:Individual
Prefix:DR
First Name:GORETTI
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 SOUTH GRAND AVE
Mailing Address - Street 2:2ND FLOOR SOUTH
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015
Mailing Address - Country:US
Mailing Address - Phone:323-669-4326
Mailing Address - Fax:323-953-3658
Practice Address - Street 1:4816 E 3RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1602
Practice Address - Country:US
Practice Address - Phone:323-780-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA79620AOtherPPIN
WA79620AOtherPPIN
W15676Medicare ID - Type Unspecified
BG8002026OtherDEA