Provider Demographics
NPI:1568903037
Name:GARCIA, NICHOLAS A (HIS)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:A
Last Name:GARCIA
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75672-4514
Mailing Address - Country:US
Mailing Address - Phone:903-297-5353
Mailing Address - Fax:903-297-5365
Practice Address - Street 1:2393 H G MOSLEY PKWY STE 102
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-3666
Practice Address - Country:US
Practice Address - Phone:903-297-5353
Practice Address - Fax:903-297-5365
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08657748237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist