Provider Demographics
NPI:1477045300
Name:GARCIA, NORIEL
Entity Type:Individual
Prefix:
First Name:NORIEL
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1362 SW 145TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-3103
Mailing Address - Country:US
Mailing Address - Phone:786-624-1283
Mailing Address - Fax:
Practice Address - Street 1:13907 CEDAR RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44118-3203
Practice Address - Country:US
Practice Address - Phone:216-485-3216
Practice Address - Fax:913-752-9116
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30025574122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes122300000XDental ProvidersDentist