Healthcare Provider Details

I. General information

NPI: 1780117838
Provider Name (Legal Business Name): ANDREA AGUALIMPIA GARCIA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH STREET
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

4114 MEDICAL DR APT 24101
SAN ANTONIO TX
78229-4023
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-8623
  • Fax:
Mailing address:
  • Phone: 956-493-0471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number97267
License Number StateZZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10059169
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: