Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 0001901 | CT |
N | 111NN1001X | Nutrition | 0001901 | CT |
N | 111NR0400X | Rehabilitation Chiropractor | 0001901 | CT |
NPI | 1831461078 |
---|---|
Provider Name | Dr. Freddys Xavier Garcia |
First Address | Bristol, CT 06010-4544 |
Second Address | Darien, CT 06820-3609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2012 |
Last Update Date | 03/02/2012 |