=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245031590
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CORALANN MARIE GARCIA MC, LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2025
-----------------------------------------------------
Last Update Date | 03/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 91-218 MAKAIKE PL
-----------------------------------------------------
City | EWA BEACH
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96706-5129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-258-0008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 91-218 MAKAIKE PL
-----------------------------------------------------
City | EWA BEACH
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96706-5129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-258-0008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | LAC-23397
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------