Provider Demographics
NPI:1205266129
Name:CLAUDIA GARCIA
Entity type:Organization
Organization Name:CLAUDIA GARCIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:LIVIER
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-614-5437
Mailing Address - Street 1:6301 MOUNTAIN VISTA ST
Mailing Address - Street 2:#205
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2364
Mailing Address - Country:US
Mailing Address - Phone:702-614-5437
Mailing Address - Fax:619-397-5356
Practice Address - Street 1:3039 W HORIZON RIDGE PKWY
Practice Address - Street 2:#110
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4192
Practice Address - Country:US
Practice Address - Phone:702-614-5437
Practice Address - Fax:619-397-5356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11568208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509669Medicaid