Provider Demographics
NPI:1750508214
Name:GARCIA, JOEL CHARLES (CRNA)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:CHARLES
Last Name:GARCIA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8098 WINONA AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2228
Mailing Address - Country:US
Mailing Address - Phone:313-382-3904
Mailing Address - Fax:
Practice Address - Street 1:8098 WINONA AVE
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2228
Practice Address - Country:US
Practice Address - Phone:313-382-3904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704234457367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered