Provider Demographics
NPI:1083259444
Name:GARCIA, TREVA (RD)
Entity Type:Individual
Prefix:
First Name:TREVA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BRICKSTONE PL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-3498
Mailing Address - Country:US
Mailing Address - Phone:256-527-6040
Mailing Address - Fax:
Practice Address - Street 1:7027 OLD MADISON PIKE NW STE 108
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-2369
Practice Address - Country:US
Practice Address - Phone:256-530-6040
Practice Address - Fax:844-878-0475
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2440133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered