Basic Information
Provider Information
NPI: 1760880827
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARCIA
FirstName: BERTHA
MiddleName: REGINA
NamePrefix:  
NameSuffix:  
Credential: LVN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11906 RAMONA AVE SPC 27
Address2:  
City: CHINO
State: CA
PostalCode: 917101690
CountryCode: US
TelephoneNumber: 3233954086
FaxNumber:  
Practice Location
Address1: 701 W. CESAR E. CHAVEZ AVE SUITE201
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 90012
CountryCode: US
TelephoneNumber: 2132175300
FaxNumber: 2132175397
Other Information
ProviderEnumerationDate: 12/05/2014
LastUpdateDate: 12/05/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
164X00000XVN176769CAY Nursing Service ProvidersLicensed Vocational Nurse 

No ID Information.


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