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General NPI Number Information
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NPI Number | 1073178703
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Entity Type | Individual
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Provider Name | OLAF RUSSELL GARCIA
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Gender | Male
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 2675 S ABILENE ST STE 100
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City | AURORA
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State | CO
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Zip | 80014-2363
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Country | US
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Telephone | 720-507-4779
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Fax | 833-941-5047
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Provider Business Mailing Address
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Address Line | 108 TWIN CREEK CIR
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City | DRIPPING SPRINGS
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State | TX
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Zip | 78620-3021
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Country | US
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Telephone | 310-600-2751
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | AP139504
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AP139504
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License Number State | TX
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