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NPI Code Detail

MEDICARE: ELIJAH GARCIA

MEDICARE: ELIJAH 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
1101YP2500XProfessional CounselorLPC-21790AZ

General Provider Information

NPI Number : 1558055830
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIJAH GARCIA
Provider Business Mailing Address
First Line : PO BOX 748465
Second Line :
City : ATLANTA
State : GA
Zip : 30374-8465
Country : US
Telephone Number : 855-284-7483
Fax Number : 617-807-0958
Provider Business Practice Location Address
First Line : 1110 E MISSOURI AVE STE 340
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-2753
Country : US
Telephone Number : 855-284-7483
Fax Number : 617-807-0958
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2023
Last Update Date : 06/08/2023

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Directions to “ ELIJAH GARCIA ” Practice Location

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