Healthcare Provider Details

I. General information

NPI: 1447170535
Provider Name (Legal Business Name): WALGELIS SEVERINO GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 CHESTNUT ST
RANDOLPH MA
02368-2459
US

IV. Provider business mailing address

309 TANAGER RD
MANKATO MN
56001-6247
US

V. Phone/Fax

Practice location:
  • Phone: 857-615-7348
  • Fax:
Mailing address:
  • Phone: 267-307-3649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: