MEDICARE: PATRICIA GARCIA LPN

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
1	164W00000X	Licensed Practical Nurse	LP039142	AZ

General Provider Information

NPI Number	:	1669800041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA GARCIA LPN

Provider Business Mailing Address
First Line	:	4029 N 79TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85033-3628
Country	:	US
Telephone Number	:	623-691-4915
Fax Number	:	623-691-4920

Provider Business Practice Location Address
First Line	:	4029 N 79TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85033-3628
Country	:	US
Telephone Number	:	623-691-4915
Fax Number	:	623-691-4920

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2013
Last Update Date	:	10/23/2013

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