Provider Demographics
NPI:1770844680
Name:GARCIA, VIVIANA (MS ED)
Entity Type:Individual
Prefix:MS
First Name:VIVIANA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3343
Mailing Address - Country:US
Mailing Address - Phone:347-256-5884
Mailing Address - Fax:
Practice Address - Street 1:246 SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-3343
Practice Address - Country:US
Practice Address - Phone:516-764-4356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY882294991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist