Provider Demographics
NPI:1013289768
Name:GARCIA, MARTINA O
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:O
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:PO BOX 2584
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540-2584
Mailing Address - Country:US
Mailing Address - Phone:956-239-0771
Mailing Address - Fax:956-316-4049
Practice Address - Street 1:801 BASS BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-5183
Practice Address - Country:US
Practice Address - Phone:956-239-0771
Practice Address - Fax:956-316-4049
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15405909171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications