Provider Demographics
NPI:1417987231
Name:GARCIA-JANIS, ELIZABETH AQUINO (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:AQUINO
Last Name:GARCIA-JANIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:GARCIA-GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:23402 MINERAL LN
Mailing Address - Street 2:
Mailing Address - City:HILL CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57745-6617
Mailing Address - Country:US
Mailing Address - Phone:605-441-7803
Mailing Address - Fax:
Practice Address - Street 1:23402 MINERAL LN
Practice Address - Street 2:
Practice Address - City:HILL CITY
Practice Address - State:SD
Practice Address - Zip Code:57745-6617
Practice Address - Country:US
Practice Address - Phone:605-441-7803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011000922084P0804X
CODR.00521412084P0804X
IN01033027A2084P0804X
KY216862084P0804X
SD92352084P0804X
HIMD-178942084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC75673Medicare UPIN
KY0046272Medicare ID - Type Unspecified