MEDICARE: C E GARCIA BS, CSAC, PNM-C

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	15419-132	WI
2	171M00000X	Case Manager/Care Coordinator
3	171R00000X	Interpreter
4	374J00000X	Doula
5	174H00000X	Health Educator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15419-132	OTHER	WI	STATE OF WISCONSIN
2	1891023818	OTHER		1891023818

General Provider Information

NPI Number	:	1891023818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	C E GARCIA BS, CSAC, PNM-C

Provider Business Mailing Address
First Line	:	PO BOX 64537
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-6937
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1314 W NATIONAL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-2114
Country	:	US
Telephone Number	:	414-949-9760
Fax Number	:

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

Provider Enumeration Date	:	12/02/2009
Last Update Date	:	11/27/2022

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