Provider Demographics
NPI:1477269736
Name:GARCIA, SEAN CRUZ
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:CRUZ
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 1:116 TERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-1601
Mailing Address - Country:US
Mailing Address - Phone:308-632-3981
Mailing Address - Fax:
Practice Address - Street 1:116 TERRY BLVD
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-1601
Practice Address - Country:US
Practice Address - Phone:308-632-3981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty