Provider Demographics
NPI:1982175618
Name:GARCIA, MAYRA ALEJANDRA
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:ALEJANDRA
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 1:571 SPRING DR
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3455
Mailing Address - Country:US
Mailing Address - Phone:408-710-9322
Mailing Address - Fax:
Practice Address - Street 1:1441 CONSTITUTION BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3127
Practice Address - Country:US
Practice Address - Phone:831-796-1705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA699372164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse