Healthcare Provider Details

I. General information

NPI: 1861853020
Provider Name (Legal Business Name): MRS. GRACIE GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E ALEXANDER ST
CUERO TX
77954-2457
US

IV. Provider business mailing address

111 E ALEXANDER ST
CUERO TX
77954-2457
US

V. Phone/Fax

Practice location:
  • Phone: 361-275-3111
  • Fax: 361-275-3112
Mailing address:
  • Phone: 361-275-3111
  • Fax: 361-275-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: