Provider Demographics
NPI:1922723337
Name:GARCIA, MARLA FERNANDA
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:FERNANDA
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 1:20225 BOTHELL EVERETT HWY APT 1114
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8185
Mailing Address - Country:US
Mailing Address - Phone:425-324-6556
Mailing Address - Fax:
Practice Address - Street 1:20225 BOTHELL EVERETT HWY APT 1114
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-8185
Practice Address - Country:US
Practice Address - Phone:425-324-6556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAD161010175126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant