=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336319284
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELENA B GARCIA MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2008
-----------------------------------------------------
Last Update Date | 08/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9280 W SUNSET RD STE 220
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89148-4861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-739-9555
-----------------------------------------------------
Fax | 702-739-9060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10120 W FLAMINGO RD STE 4-142
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89147-8392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-739-9555
-----------------------------------------------------
Fax | 702-739-9060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ELENA B GARCIA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 702-739-9555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------