Healthcare Provider Details

I. General information

NPI: 1720016280
Provider Name (Legal Business Name): DELIA M GARCIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 09/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DES PERES RD SUITE 100
DES PERES MO
63131-2050
US

IV. Provider business mailing address

11475 OLDE CABIN RD SUITE 200
SAINT LOUIS MO
63141-7128
US

V. Phone/Fax

Practice location:
  • Phone: 314-989-1300
  • Fax: 314-989-1323
Mailing address:
  • Phone: 314-991-8200
  • Fax: 314-569-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberR3B44
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberR3B44
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: