Provider Demographics
NPI:1104308220
Name:GARCIA, INGRIS (RDN, CDN)
Entity type:Individual
Prefix:
First Name:INGRIS
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8008 135TH ST APT 307
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1009
Mailing Address - Country:US
Mailing Address - Phone:347-866-4637
Mailing Address - Fax:
Practice Address - Street 1:1979 MARCUS AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1076
Practice Address - Country:US
Practice Address - Phone:516-353-4151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86033805133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered