Provider Demographics
NPI:1376279240
Name:GARCIA, MYRNA IVETTE
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:IVETTE
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 1:8543 STATE HIGHWAY 151 APT 1337
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-3278
Mailing Address - Country:US
Mailing Address - Phone:956-221-1200
Mailing Address - Fax:
Practice Address - Street 1:8543 STATE HIGHWAY 151 APT 1337
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-3278
Practice Address - Country:US
Practice Address - Phone:956-221-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110422235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist