Healthcare Provider Details

I. General information

NPI: 1073792354
Provider Name (Legal Business Name): DR. RONNIETTE CRISTINA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. RONNIETTE CRISTINA LEIFERT

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 5TH AVE APT 1K
NEW YORK NY
10011-8859
US

IV. Provider business mailing address

30 5TH AVE APT 1K
NEW YORK NY
10011-8859
US

V. Phone/Fax

Practice location:
  • Phone: 212-533-7880
  • Fax: 212-533-0162
Mailing address:
  • Phone: 212-533-7880
  • Fax: 212-533-0162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number053697-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: