Provider Demographics
NPI:1336459296
Name:GARCIA, BIANCA ELISA
Entity Type:Individual
Prefix:MISS
First Name:BIANCA
Middle Name:ELISA
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 1:1901 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2956
Mailing Address - Country:US
Mailing Address - Phone:956-542-8504
Mailing Address - Fax:956-542-6510
Practice Address - Street 1:1901 E 22ND ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2956
Practice Address - Country:US
Practice Address - Phone:956-542-8504
Practice Address - Fax:956-542-6510
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113782225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286091805Medicaid
TX45-4849OtherMEDICARE
TX169033101Medicaid
TX286091804Medicaid