Healthcare Provider Details

I. General information

NPI: 1174852537
Provider Name (Legal Business Name): PAIGE GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 3RD AVE SW STE 2
CARMEL IN
46032-7500
US

IV. Provider business mailing address

1389 W 86TH ST # 170
INDIANAPOLIS IN
46260-2101
US

V. Phone/Fax

Practice location:
  • Phone: 317-564-0934
  • Fax:
Mailing address:
  • Phone: 317-564-0934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-31003
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: