Provider Demographics
NPI:1760651335
Name:WILLIAM GARNICA A MEDICAL CORPORATION
Entity type:Organization
Organization Name:WILLIAM GARNICA A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-233-0335
Mailing Address - Street 1:2384 E GETTYSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-0320
Mailing Address - Country:US
Mailing Address - Phone:559-233-0335
Mailing Address - Fax:559-233-0315
Practice Address - Street 1:2384 E GETTYSBURG AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0320
Practice Address - Country:US
Practice Address - Phone:559-233-0335
Practice Address - Fax:559-233-0315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A677520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23291ZMedicare PIN