Provider Demographics
NPI:1114702917
Name:GARCIA, GUADALUPE
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 N 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:STONE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60165-1026
Mailing Address - Country:US
Mailing Address - Phone:708-548-0247
Mailing Address - Fax:
Practice Address - Street 1:1702 N 35TH AVE
Practice Address - Street 2:
Practice Address - City:STONE PARK
Practice Address - State:IL
Practice Address - Zip Code:60165-1026
Practice Address - Country:US
Practice Address - Phone:708-548-0247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program