Provider Demographics
NPI:1699912576
Name:GARCIA, ROSA E
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:E
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27613 ENNISMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3414
Mailing Address - Country:US
Mailing Address - Phone:661-257-4242
Mailing Address - Fax:
Practice Address - Street 1:28237 NEWHALL RANCH RD
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-0986
Practice Address - Country:US
Practice Address - Phone:661-257-4242
Practice Address - Fax:661-294-0020
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70414126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant