Provider Demographics
NPI:1770017899
Name:GARCIA, TOMMY ANGELO
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:ANGELO
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 OLD STERLINGTON RD APT 238
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2636
Mailing Address - Country:US
Mailing Address - Phone:318-791-0166
Mailing Address - Fax:
Practice Address - Street 1:3111 OLD STERLINGTON RD APT 238
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2636
Practice Address - Country:US
Practice Address - Phone:318-791-0166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician