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NPI Code Detail

MEDICARE: OLAF RUSSELL GARCIA

MEDICARE: OLAF RUSSELL GARCIA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1364SG0600XGerontology Clinical Nurse SpecialistAP139504TX
2363LG0600XGerontology Nurse PractitionerAP139504TX

General Provider Information

NPI Number : 1073178703
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLAF RUSSELL GARCIA
Provider Business Mailing Address
First Line : 108 TWIN CREEK CIR
Second Line :
City : DRIPPING SPRINGS
State : TX
Zip : 78620-3021
Country : US
Telephone Number : 310-600-2751
Fax Number :
Provider Business Practice Location Address
First Line : 2675 S ABILENE ST STE 100
Second Line :
City : AURORA
State : CO
Zip : 80014-2363
Country : US
Telephone Number : 720-507-4779
Fax Number : 833-941-5047
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2019
Last Update Date : 08/20/2024

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Directions to “ OLAF RUSSELL GARCIA ” Practice Location

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