Individual
JACOB GARZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3380 LA SIERRA AVE STE 108, RIVERSIDE, CA 92503-5225
(951) 465-6982
Mailing address
12335 MARQUETTE CT, MORENO VALLEY, CA 92557-7749
(951) 479-6589
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
87646
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
07/25/2018
Last updated
07/25/2018
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