Provider Demographics
NPI:1881281152
Name:GARCIA, MARIA IMELDA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:IMELDA
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 1:1100 W 49TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3101
Mailing Address - Country:US
Mailing Address - Phone:512-776-7500
Mailing Address - Fax:512-776-7489
Practice Address - Street 1:1100 W 49TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3101
Practice Address - Country:US
Practice Address - Phone:512-776-7500
Practice Address - Fax:512-776-7489
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32-0113643Medicaid
TX320113643Medicaid