Provider Demographics
NPI:1649381898
Name:GARCIA, ALFONSO JR (RD, LD)
Entity Type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:
Last Name:GARCIA
Suffix:JR
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 N MILAM ST
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-4735
Mailing Address - Country:US
Mailing Address - Phone:956-456-4260
Mailing Address - Fax:956-428-4628
Practice Address - Street 1:229 N MILAM ST
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-4735
Practice Address - Country:US
Practice Address - Phone:956-456-4260
Practice Address - Fax:956-428-4628
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06743133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT06743OtherLICENSED DIETITIAN
TX928783OtherREGISTERED DIETITIAN