Healthcare Provider Details

I. General information

NPI: 1417987231
Provider Name (Legal Business Name): ELIZABETH AQUINO GARCIA-JANIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH A. GARCIA-GRAY MD

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23402 MINERAL LN
HILL CITY SD
57745-6617
US

IV. Provider business mailing address

23402 MINERAL LN
HILL CITY SD
57745-6617
US

V. Phone/Fax

Practice location:
  • Phone: 605-441-7803
  • Fax:
Mailing address:
  • Phone: 605-441-7803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301100092
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberDR.0052141
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number01033027A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number21686
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number9235
License Number StateSD
# 6
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD-17894
License Number StateHI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: