Provider Demographics
NPI:1447764550
Name:GARCIA, ELIZABETH ARIEL (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ARIEL
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 WAVERLY DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-7039
Mailing Address - Country:US
Mailing Address - Phone:209-631-2033
Mailing Address - Fax:
Practice Address - Street 1:1920 FOOTBALL DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-4829
Practice Address - Country:US
Practice Address - Phone:847-615-2327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000216052255A2300X
TXAT70742255A2300X
IL096.0049002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer