Healthcare Provider Details

I. General information

NPI: 1891574315
Provider Name (Legal Business Name): ADRIANA NICOLE GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W. SOUTH STREET P.O. BOX 218
LEANDER TX
78646-0218
US

IV. Provider business mailing address

14300 TANDEM BLVD APT 180
AUSTIN TX
78728-6614
US

V. Phone/Fax

Practice location:
  • Phone: 512-570-0000
  • Fax:
Mailing address:
  • Phone: 832-597-0824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number121285
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: