Healthcare Provider Details

I. General information

NPI: 1659961183
Provider Name (Legal Business Name): ANA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 01/19/2021
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 SE 8TH TER STE A
CAPE CORAL FL
33990-3289
US

IV. Provider business mailing address

910 SW 11TH PL
CAPE CORAL FL
33991-2456
US

V. Phone/Fax

Practice location:
  • Phone: 239-574-2000
  • Fax: 239-574-1144
Mailing address:
  • Phone: 239-839-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH16367
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: