Provider Demographics
NPI:1457619793
Name:GARCIA, ANDRES
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name: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 1:5916 W 34TH ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-6430
Mailing Address - Country:US
Mailing Address - Phone:281-989-2239
Mailing Address - Fax:832-735-2048
Practice Address - Street 1:5916 W 34TH ST
Practice Address - Street 2:SUITE K
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-6430
Practice Address - Country:US
Practice Address - Phone:281-989-2239
Practice Address - Fax:832-735-2048
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1015053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1815169801Medicaid
TX1815169801Medicaid