Healthcare Provider Details

I. General information

NPI: 1124830690
Provider Name (Legal Business Name): ALYSIA MARTIN GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 N CEDAR ST
LANSING MI
48912-1285
US

IV. Provider business mailing address

313 N CEDAR ST
LANSING MI
48912-1285
US

V. Phone/Fax

Practice location:
  • Phone: 831-706-6767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: