Healthcare Provider Details

I. General information

NPI: 1457750713
Provider Name (Legal Business Name): DAVID RAY GARCIA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2014
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 BROADWAY
NEW YORK NY
10018-2301
US

IV. Provider business mailing address

1440 BROADWAY
NEW YORK NY
10018-2301
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax: 401-216-3854
Mailing address:
  • Phone: 866-389-2727
  • Fax: 401-216-3854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP126511
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number339042
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: