Provider Demographics
NPI:1669920575
Name:HORTON-GARCIA, DERINA (CERTIFIED HAIR LOSS)
Entity type:Individual
Prefix:MRS
First Name:DERINA
Middle Name:
Last Name:HORTON-GARCIA
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:DERINA
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTIFIED HAIR LOSS
Mailing Address - Street 1:5214 SILTSTONE LOOP
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5815
Mailing Address - Country:US
Mailing Address - Phone:254-220-9921
Mailing Address - Fax:
Practice Address - Street 1:3901 E STAN SCHLUETER LOOP
Practice Address - Street 2:STE 201
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-4516
Practice Address - Country:US
Practice Address - Phone:254-220-9921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11781651744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management