Healthcare Provider Details

I. General information

NPI: 1003683699
Provider Name (Legal Business Name): HARRISON GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 W BELMONT AVE STE 200
CHICAGO IL
60657-5785
US

IV. Provider business mailing address

420 E SUPERIOR ST
CHICAGO IL
60611-4494
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-3627
  • Fax: 773-248-3001
Mailing address:
  • Phone: 312-503-8194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number477779
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE3513558
License Number State
# 3
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE0917112
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: