Provider Demographics
NPI:1831917566
Name:GARCIA, DIXIE DIANE
Entity type:Individual
Prefix:
First Name:DIXIE
Middle Name:DIANE
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 1:6221 NE FOURTH PLAIN BLVD APT 130
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-7210
Mailing Address - Country:US
Mailing Address - Phone:360-672-9080
Mailing Address - Fax:360-952-8641
Practice Address - Street 1:6221 NE FOURTH PLAIN BLVD APT 130
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7210
Practice Address - Country:US
Practice Address - Phone:360-672-9080
Practice Address - Fax:360-952-8641
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61591278175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist