Provider Demographics
NPI:1528792496
Name:GARCIA, JOSE IVAN
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:IVAN
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 1:4275 W 4TH ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-8806
Mailing Address - Country:US
Mailing Address - Phone:702-539-2423
Mailing Address - Fax:
Practice Address - Street 1:3360 S MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6442
Practice Address - Country:US
Practice Address - Phone:775-825-0557
Practice Address - Fax:775-825-3557
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV22941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist