Provider Demographics
NPI:1679836407
Name:GARCIA, ANGIE
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 KOSCIUSZKO ST
Mailing Address - Street 2:#2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-2300
Mailing Address - Country:US
Mailing Address - Phone:646-479-8980
Mailing Address - Fax:
Practice Address - Street 1:558 KOSCIUSZKO ST
Practice Address - Street 2:#2B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-2300
Practice Address - Country:US
Practice Address - Phone:646-479-8980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator