Healthcare Provider Details

I. General information

NPI: 1861230740
Provider Name (Legal Business Name): MELISSA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PALO ALTO RD STE 120
SAN ANTONIO TX
78211-3773
US

IV. Provider business mailing address

15726 CHASE HILL BLVD APT 107A
SAN ANTONIO TX
78256-1010
US

V. Phone/Fax

Practice location:
  • Phone: 210-922-1785
  • Fax:
Mailing address:
  • Phone: 210-739-8898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number209978
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: