Provider Demographics
NPI:1053325266
Name:GARCIA, MARISSA G (RD LD)
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:G
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 NELSON CT
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-7500
Mailing Address - Country:US
Mailing Address - Phone:956-727-5365
Mailing Address - Fax:
Practice Address - Street 1:6551 STAR CT
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-9140
Practice Address - Country:US
Practice Address - Phone:956-523-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT03997133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered