Provider Demographics
NPI:1679173447
Name:GARCIA, ANTONIA MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:MARIE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 E COPPER ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-3006
Mailing Address - Country:US
Mailing Address - Phone:602-369-6327
Mailing Address - Fax:
Practice Address - Street 1:6262 N SWAN RD STE 160
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-3636
Practice Address - Country:US
Practice Address - Phone:520-955-4064
Practice Address - Fax:520-254-6003
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005335103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical