Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | A006182 | AR |
NPI | 1083176564 |
---|---|
Provider Name | Theresia Garcia |
First Address | Little Rock, AR 72205-5416 |
Second Address | Sherwood, AR 72120-5089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2019 |
Last Update Date | 03/04/2019 |