Provider Demographics
NPI:1861853020
Name:GARCIA, GRACIE
Entity Type:Individual
Prefix:MRS
First Name:GRACIE
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 1:111 E ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-2457
Mailing Address - Country:US
Mailing Address - Phone:361-275-3111
Mailing Address - Fax:361-275-3112
Practice Address - Street 1:111 E ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-2457
Practice Address - Country:US
Practice Address - Phone:361-275-3111
Practice Address - Fax:361-275-3112
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care