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NPI Code Detail

MEDICARE: JERRY GARCIA

MEDICARE: JERRY 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
1224Z00000XOccupational Therapy Assistant3319NV

General Provider Information

NPI Number : 1740067156
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRY GARCIA
Provider Business Mailing Address
First Line : 6174 MEADOWGRASS LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-1118
Country : US
Telephone Number : 435-212-1335
Fax Number :
Provider Business Practice Location Address
First Line : 3965 W CHEYENNE AVE STE 101
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-8905
Country : US
Telephone Number : 702-515-4009
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2023
Last Update Date : 09/11/2023

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Directions to “ JERRY GARCIA ” Practice Location

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