Provider Demographics
NPI:1649235763
Name:GARCIA, DIANE L (LMT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:L
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-2155
Mailing Address - Country:US
Mailing Address - Phone:585-317-7815
Mailing Address - Fax:
Practice Address - Street 1:4138 W HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-5224
Practice Address - Country:US
Practice Address - Phone:585-334-4060
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018545174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY15536473OtherPREFERRED CARE