Provider Demographics
NPI:1699463737
Name:GARCIA, RENE RICHARD (LVN)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:RICHARD
Last Name:GARCIA
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2939 CUDAHY ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-6828
Mailing Address - Country:US
Mailing Address - Phone:323-861-2124
Mailing Address - Fax:
Practice Address - Street 1:1500 E GAGE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-1724
Practice Address - Country:US
Practice Address - Phone:323-581-0964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA710909164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse