Provider Demographics
NPI:1164821849
Name:GARCIA, LAURA
Entity Type:Individual
Prefix:MS
First Name:LAURA
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 1:530 W 153RD ST
Mailing Address - Street 2:APT.12
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-1036
Mailing Address - Country:US
Mailing Address - Phone:646-228-2218
Mailing Address - Fax:
Practice Address - Street 1:530 W 153RD ST
Practice Address - Street 2:APT.12
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-1036
Practice Address - Country:US
Practice Address - Phone:646-228-2218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY869990174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist