Healthcare Provider Details

I. General information

NPI: 1619450038
Provider Name (Legal Business Name): MARIA CORAZON BATUCAN GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 03/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 4TH ST
LUBBOCK TX
79415-5346
US

IV. Provider business mailing address

3611 PONTIAC AVE
LUBBOCK TX
79407-1823
US

V. Phone/Fax

Practice location:
  • Phone: 806-763-4455
  • Fax:
Mailing address:
  • Phone: 806-283-8283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2102470
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1315933
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: