Provider Demographics
NPI:1801982640
Name:GARCIA, AIDA L
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:L
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AIDA
Other - Middle Name:L
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3940 10TH AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:LAKEWORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461
Mailing Address - Country:US
Mailing Address - Phone:561-964-5325
Mailing Address - Fax:561-964-0332
Practice Address - Street 1:3940 10TH AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:LAKEWORTH
Practice Address - State:FL
Practice Address - Zip Code:33461
Practice Address - Country:US
Practice Address - Phone:561-964-5325
Practice Address - Fax:561-964-0332
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1191332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1029220001Medicare NSC