Provider Demographics
NPI:1235856907
Name:FERREYRA GARCIA, JUDITH
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:FERREYRA 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 1:122 W FRANKLIN AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2454
Mailing Address - Country:US
Mailing Address - Phone:612-913-1491
Mailing Address - Fax:
Practice Address - Street 1:10445 KALEN DR NE
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MN
Practice Address - Zip Code:55341-4106
Practice Address - Country:US
Practice Address - Phone:612-310-4396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker