Healthcare Provider Details

I. General information

NPI: 1285156943
Provider Name (Legal Business Name): DANIELLA SELENE GARCIA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD
DALLAS TX
75216-7167
US

IV. Provider business mailing address

4417 S LANCASTER RD APT 1463
DALLAS TX
75216-7277
US

V. Phone/Fax

Practice location:
  • Phone: 214-516-2925
  • Fax:
Mailing address:
  • Phone: 210-363-6133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number904881
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: