Provider Demographics
NPI:1669194528
Name:GARCIA- INGRAM, ALICIA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:GARCIA- INGRAM
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 1:20400 SUPERIOR RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-5362
Mailing Address - Country:US
Mailing Address - Phone:734-558-0565
Mailing Address - Fax:734-282-7105
Practice Address - Street 1:20400 SUPERIOR RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5362
Practice Address - Country:US
Practice Address - Phone:734-558-0565
Practice Address - Fax:734-282-7105
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker