Provider Demographics
NPI:1619190949
Name:GARCIA, MAGDA I (LVN)
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:I
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 E FM 495 STE 7-8
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-4863
Mailing Address - Country:US
Mailing Address - Phone:956-783-0502
Mailing Address - Fax:956-783-0569
Practice Address - Street 1:1209 E FM 495 STE 7-8
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-4863
Practice Address - Country:US
Practice Address - Phone:956-783-0502
Practice Address - Fax:956-783-0569
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010067Medicaid