Healthcare Provider Details

I. General information

NPI: 1487683371
Provider Name (Legal Business Name): EILEEN TALUSAN-GARCIA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 QUAKER AVE
LUBBOCK TX
79424-3367
US

IV. Provider business mailing address

PO BOX 16757
LUBBOCK TX
79490-6757
US

V. Phone/Fax

Practice location:
  • Phone: 806-793-7257
  • Fax: 806-799-1568
Mailing address:
  • Phone: 806-785-2045
  • Fax: 806-785-0872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK5014
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberK5014
License Number StateTX

VIII. Authorized Official

Name: MR. CLAY P GARRISON
Title or Position: COORDINATOR, MANAGED CARE
Credential:
Phone: 806-785-7676