Provider Demographics
NPI:1093900599
Name:GARCIA, RICKIE (CST/FA)
Entity Type:Individual
Prefix:
First Name:RICKIE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:CST/FA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 EAGLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3906
Mailing Address - Country:US
Mailing Address - Phone:719-238-0117
Mailing Address - Fax:719-268-1711
Practice Address - Street 1:1130 EAGLE ROCK RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3906
Practice Address - Country:US
Practice Address - Phone:719-238-0117
Practice Address - Fax:719-268-1711
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-08
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist