Healthcare Provider Details

I. General information

NPI: 1891797890
Provider Name (Legal Business Name): SANDRA PATRICIA GARCIA DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 SOUTHERN BLVD
BRONX NY
10459-4507
US

IV. Provider business mailing address

7802 65TH ST
GLENDALE NY
11385-6804
US

V. Phone/Fax

Practice location:
  • Phone: 718-542-0472
  • Fax: 718-709-7652
Mailing address:
  • Phone: 718-542-0472
  • Fax: 718-893-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberNOO5534
License Number StateNY

VIII. Authorized Official

Name: DR. SANDRA PATRICIA GARCIA
Title or Position: OWNER
Credential: DPM
Phone: 718-542-0472