MEDICARE: GIOVANNI 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	314644-1	NY

General Provider Information

NPI Number	:	1871934141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIOVANNI GARCIA

Provider Business Mailing Address
First Line	:	51 S RIDGE RD
Second Line	:
City	:	POMONA
State	:	NY
Zip	:	10970-2105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 S RIDGE RD
Second Line	:
City	:	POMONA
State	:	NY
Zip	:	10970-2105
Country	:	US
Telephone Number	:	845-362-5173
Fax Number	:

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

Provider Enumeration Date	:	07/15/2013
Last Update Date	:	07/15/2013

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