=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164857728
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA CHRISTINE GARCIA SLPA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2013
-----------------------------------------------------
Last Update Date | 09/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13801 E BENSON HWY
-----------------------------------------------------
City | VAIL
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85641-9074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-879-2072
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9831 E PINYON PINE DR
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85748-7895
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-271-5173
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2355S0801X
-----------------------------------------------------
Taxonomy Name | Speech-Language Assistant
-----------------------------------------------------
License Number | SLPA7998
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------