Healthcare Provider Details

I. General information

NPI: 1649235763
Provider Name (Legal Business Name): DIANE L GARCIA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4138 W HENRIETTA RD
ROCHESTER NY
14623-5224
US

IV. Provider business mailing address

23 WOODLAWN AVE
FAIRPORT NY
14450-2155
US

V. Phone/Fax

Practice location:
  • Phone: 585-334-4060
  • Fax:
Mailing address:
  • Phone: 585-317-7815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number018545
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: