Provider Demographics
NPI:1396365268
Name:GARCIA, LAURA
Entity Type:Individual
Prefix:
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 1:5236 SOCIALVILLE FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9302
Mailing Address - Country:US
Mailing Address - Phone:513-347-9999
Mailing Address - Fax:513-573-9178
Practice Address - Street 1:5236 SOCIALVILLE FOSTER RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9302
Practice Address - Country:US
Practice Address - Phone:513-347-9999
Practice Address - Fax:513-573-9178
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006366363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant