Provider Demographics
NPI:1497343479
Name:GARCIA, JOSEPHA CALICDAN III (RN BSN CNOR)
Entity Type:Individual
Prefix:
First Name:JOSEPHA
Middle Name:CALICDAN
Last Name:GARCIA
Suffix:III
Gender:F
Credentials:RN BSN CNOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 BURMONT RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2822
Mailing Address - Country:US
Mailing Address - Phone:267-918-5840
Mailing Address - Fax:
Practice Address - Street 1:234 BURMONT RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-2822
Practice Address - Country:US
Practice Address - Phone:267-918-5840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA537471163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice