Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 019028036 | IL |
Y | 1223G0001X | General Practice | 019028036 | IL |
Y | 213EG0000X | General Practice | 019028036 | IL |
NPI | 1003044082 |
---|---|
Provider Name | Gandy S Garcia |
First Address | Melrose Park, IL 60160-3017 |
Second Address | Chicago, IL 60623-3704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2009 |
Last Update Date | 29/06/2009 |