Healthcare Provider Details

I. General information

NPI: 1194051516
Provider Name (Legal Business Name): ERICA LEE GARCIA SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: N/A N/A M.S., CFY-SLP

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5633 S. STAPLES STREET SUITE 400 & 500
CORPUS CHRISTI TX
78411-4646
US

IV. Provider business mailing address

5322 SARATOGA BLVD. APT. 122
CORPUS CHRISTI TX
78413-2397
US

V. Phone/Fax

Practice location:
  • Phone: 361-855-1352
  • Fax: 361-855-1254
Mailing address:
  • Phone: 361-228-3503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number104765
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: