Provider Demographics
NPI:1467227041
Name:GARCIA, FITHRIA SURAYA
Entity Type:Individual
Prefix:
First Name:FITHRIA
Middle Name:SURAYA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FITHRIA
Other - Middle Name:SURAYA
Other - Last Name:BASHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1528 W WARM SPRINGS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-4332
Mailing Address - Country:US
Mailing Address - Phone:702-213-5601
Mailing Address - Fax:
Practice Address - Street 1:1528 W WARM SPRINGS RD STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-4332
Practice Address - Country:US
Practice Address - Phone:702-213-5601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-24
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV871734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty