Provider Demographics
NPI:1437661667
Name:GARCIA, LYDIA E
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:E
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 1:244 S 3RD ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-5621
Mailing Address - Country:US
Mailing Address - Phone:917-564-4656
Mailing Address - Fax:
Practice Address - Street 1:6 MALCOLM X BLVD # 2A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-5646
Practice Address - Country:US
Practice Address - Phone:917-564-4656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist