Individual provider Active NPI

Luis Obispo Garcia-Nique, M.D.

  • General Practice Physician
  • Garden Grove, CA
National Provider Identifier
1003955519
Registry record updated Jun 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A33647 Issued in CA
Practice address
12555 Garden Grove Blvd Ste 202
Garden Grove, CA 92843-1903
Phone
(714) 394-5767
Fax
(714) 516-9860
NPI assigned
Feb 5, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X A33647 CA Primary

Addresses

Primary practice location

12555 Garden Grove Blvd Ste 202
Garden Grove, CA 92843-1903

Mailing address

12555 Garden Grove Blvd Ste 202
Garden Grove, CA 92843-1903
Phone (714) 394-5767

Other identifiers 1

IdentifierTypeStateIssuer
00A336470MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110512000863 CA Practitioner - Obstetrics/GynecologyPractitioner - Preventive MedicinePractitioner - General Practice 9931385697 Practice locations: Anaheim, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Garcia Medical Clinic Inc Current Accepting new patients

Locations

2090 S Euclid St
Ste 104
Anaheim, CA 92802
Phone (714) 539-2200

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782172800000",
    "number": "1003955519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12555 GARDEN GROVE BLVD STE 202",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431903",
            "telephone_number": "714-394-5767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12555 GARDEN GROVE BLVD STE 202",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431903",
            "telephone_number": "714-394-5767",
            "fax_number": "714-516-9860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARCIA-NIQUE",
        "first_name": "LUIS",
        "middle_name": "OBISPO",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2026-06-23",
        "certification_date": "2026-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A33647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A336470",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

Verify at the official NPI Registry.