Provider Demographics
NPI:1083026850
Name:GARCIA, YAMIRA (LIC # 891)
Entity Type:Individual
Prefix:
First Name:YAMIRA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LIC # 891
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JARDINES DE QUINTANA 7
Mailing Address - Street 2:BLOQUE B APTO 16
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917
Mailing Address - Country:US
Mailing Address - Phone:787-309-1237
Mailing Address - Fax:
Practice Address - Street 1:1001 CALLE AMBERES
Practice Address - Street 2:ESQUINA ANDALUCIA PUERTO NUEVO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-309-1237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR891156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician