Provider Demographics
NPI:1518448489
Name:GARCIA, MICHELLE ALEXANDRA
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ALEXANDRA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ALEXANDRA
Other - Last Name:GALLEGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 RIVERDALE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4903
Mailing Address - Country:US
Mailing Address - Phone:929-447-5262
Mailing Address - Fax:929-447-5260
Practice Address - Street 1:1 RIVERDALE AVE STE 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4903
Practice Address - Country:US
Practice Address - Phone:929-447-5262
Practice Address - Fax:929-447-5260
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator