Basic Information
| Provider Information | |||||||||
| NPI: | 1750375150 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | ELENA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 503 MEDICAL CENTER BLVD | ||||||||
| Address2: | STE. 100 | ||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773042809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9367881060 | ||||||||
| FaxNumber: | 9367882844 | ||||||||
| Practice Location | |||||||||
| Address1: | 503 MEDICAL CENTER BLVD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773042809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9367881060 | ||||||||
| FaxNumber: | 9367882844 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | L1050 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080191575 | 01 | TX | RAILROAD MEDICARE | OTHER | 150961401 | 05 | TX | MEDICAID | 037714502 | 05 | TX | MEDICAID | 8G0690 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |