Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 214002 | TX |
NPI | 1013461052 |
---|---|
Provider Name | Diego Garcia |
First Address | Brownsville, TX 78520-8268 |
Second Address | Brownsville, TX 78520-8268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2016 |
Last Update Date | 08/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
214002 | STATE LICENSE (01) | TX |