Provider Demographics
NPI:1073492005
Name:GARCIA, LUIS ANTONIO (MA61559469)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ANTONIO
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MA61559469
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 433
Mailing Address - Street 2:
Mailing Address - City:WHITE SWAN
Mailing Address - State:WA
Mailing Address - Zip Code:98952-0433
Mailing Address - Country:US
Mailing Address - Phone:509-406-9593
Mailing Address - Fax:
Practice Address - Street 1:3910 SUMMITVIEW AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2780
Practice Address - Country:US
Practice Address - Phone:509-823-7592
Practice Address - Fax:509-424-3104
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61559469225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist