Provider Demographics
NPI:1114980471
Name:GARCIA, IRMA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:IRMA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W ATEN RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-9805
Mailing Address - Country:US
Mailing Address - Phone:760-355-7730
Mailing Address - Fax:760-355-7731
Practice Address - Street 1:1550 N IMPERIAL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-6304
Practice Address - Country:US
Practice Address - Phone:760-353-4710
Practice Address - Fax:760-545-0244
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP12225363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13536OtherGROUP PTAN
CARN410093Medicaid