Provider Demographics
NPI:1790874477
Name:GARCIA, ROBIN WHITE (PAC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:WHITE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 S J ST STE 120
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4965
Mailing Address - Country:US
Mailing Address - Phone:253-428-2200
Mailing Address - Fax:253-428-2299
Practice Address - Street 1:1812 S J ST STE 120
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4965
Practice Address - Country:US
Practice Address - Phone:253-428-2200
Practice Address - Fax:253-428-2299
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOA60814960363A00000X
WAPA10004191363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1019161Medicaid
WA8322448Medicaid
WA8322448Medicaid