Provider Demographics
NPI:1063013258
Name:GARCIA, IRIS MASSIEL (NP)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:MASSIEL
Last Name:GARCIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:IRIS
Other - Middle Name:MASSIEL
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:2206 DR MARTIN L KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-1307
Mailing Address - Country:US
Mailing Address - Phone:646-785-0034
Mailing Address - Fax:
Practice Address - Street 1:2206 DR MARTIN L KING JR BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-1307
Practice Address - Country:US
Practice Address - Phone:646-785-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily