MEDICARE: GRISSELL 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
1	164W00000X	Licensed Practical Nurse	292416-1	NY

General Provider Information

NPI Number	:	1790086361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRISSELL GARCIA

Provider Business Mailing Address
First Line	:	56 MARCUS GARVEY BLVD
Second Line	:	#2 E
City	:	BROOKLYN
State	:	NY
Zip	:	11206-5813
Country	:	US
Telephone Number	:	347-645-7210
Fax Number	:

Provider Business Practice Location Address
First Line	:	56 MARCUS GARVEY BLVD
Second Line	:	#2 E
City	:	BROOKLYN
State	:	NY
Zip	:	11206-5813
Country	:	US
Telephone Number	:	347-645-7210
Fax Number	:

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

Provider Enumeration Date	:	11/12/2010
Last Update Date	:	11/12/2010

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