Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 6555 | AZ |
NPI | 1043459209 |
---|---|
Provider Name | Audrey R Garcia |
First Address | Chandler, AZ 85248-3001 |
Second Address | Chandler, AZ 85248-3001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2009 |
Last Update Date | 11/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6555 | STATE LICENCE (01) | AR |