Basic Information
| Provider Information | |||||||||
| NPI: | 1982175618 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | MAYRA | ||||||||
| MiddleName: | ALEJANDRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 571 SPRING DR | ||||||||
| Address2: | |||||||||
| City: | HOLLISTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950233455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087109322 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1441 CONSTITUTION BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939063127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317961705 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2018 | ||||||||
| LastUpdateDate: | 12/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 699372 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.