Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1282530 | TX |
NPI | 1376023960 |
---|---|
Provider Name | Desiree Garcia Garlejo |
First Address | Corpus Christi, TX 78418-1430 |
Second Address | Corpus Christi, TX 78414-3306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2018 |
Last Update Date | 29/12/2018 |