Provider Demographics
NPI:1447039219
Name:GARCIA, SALOMON
Entity type:Individual
Prefix:
First Name:SALOMON
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 BROOKDALE DR APT 20
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6273
Mailing Address - Country:US
Mailing Address - Phone:925-324-7663
Mailing Address - Fax:
Practice Address - Street 1:744 EMPIRE ST # 160
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5562
Practice Address - Country:US
Practice Address - Phone:707-399-9413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency