Healthcare Provider Details

I. General information

NPI: 1881281152
Provider Name (Legal Business Name): MARIA IMELDA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 12/21/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W 49TH ST
AUSTIN TX
78756-3101
US

IV. Provider business mailing address

1100 W 49TH ST
AUSTIN TX
78756-3101
US

V. Phone/Fax

Practice location:
  • Phone: 512-776-7500
  • Fax: 512-776-7489
Mailing address:
  • Phone: 512-776-7500
  • Fax: 512-776-7489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: