Healthcare Provider Details

I. General information

NPI: 1710794151
Provider Name (Legal Business Name): MARIA D GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 12TH AVE SE
PUYALLUP WA
98372-4030
US

IV. Provider business mailing address

1819 12TH AVE SE
PUYALLUP WA
98372-4030
US

V. Phone/Fax

Practice location:
  • Phone: 253-304-9287
  • Fax:
Mailing address:
  • Phone: 253-304-9287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number006010
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: