Basic Information
| Provider Information | |||||||||
| NPI: | 1598348468 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARNICA | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | LETICIA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12767 BRIDGEWATER DR | ||||||||
| Address2: | |||||||||
| City: | EASTVALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928808848 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 15740 WHITTWOOD LN | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906032326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629430118 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2021 | ||||||||
| LastUpdateDate: | 05/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 34798 | CA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.