Healthcare Provider Details

I. General information

NPI: 1396283545
Provider Name (Legal Business Name): SANTIAGO SERGIO GARCIA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W HILLSIDE RD SUITE 9
LAREDO TX
78041-6903
US

IV. Provider business mailing address

220 W HILLSIDE RD SUITE 9
LAREDO TX
78041-6903
US

V. Phone/Fax

Practice location:
  • Phone: 956-724-5656
  • Fax: 956-726-3093
Mailing address:
  • Phone: 956-724-5656
  • Fax: 956-726-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number224771
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: