Provider Demographics
NPI:1942536297
Name:GARCIA-GARCIA, LUIS MIGUEL
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:MIGUEL
Last Name:GARCIA-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 1:2920 ALDRICH AVE S
Mailing Address - Street 2:#453
Mailing Address - City:MPLS
Mailing Address - State:MN
Mailing Address - Zip Code:55408
Mailing Address - Country:US
Mailing Address - Phone:612-801-5195
Mailing Address - Fax:
Practice Address - Street 1:2920 BRYANT AVE S
Practice Address - Street 2:#1
Practice Address - City:MPLS
Practice Address - State:MN
Practice Address - Zip Code:55408
Practice Address - Country:US
Practice Address - Phone:612-824-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist