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General NPI Number Information
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NPI Number | 1740787118
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Entity Type | Individual
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Provider Name | ALFREDO AMARU VANIN GARCIA
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Gender | Male
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 04/11/2018
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Provider Practice Location Address
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Address Line | 713 SW C AVE
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City | LAWTON
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State | OK
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Zip | 73501-4311
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Country | US
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Telephone | 580-699-2023
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Fax |
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Provider Business Mailing Address
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Address Line | 4030 SW MESQUITE DR
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City | LAWTON
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State | OK
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Zip | 73505-7558
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Country | US
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Telephone | 580-647-9547
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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