Provider Demographics
NPI:1285743039
Name:DANIEL H & EMILY B GARCIA
Entity type:Organization
Organization Name:DANIEL H & EMILY B GARCIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:B
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-853-8183
Mailing Address - Street 1:7438 S D AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CONCRETE
Mailing Address - State:WA
Mailing Address - Zip Code:98237-9642
Mailing Address - Country:US
Mailing Address - Phone:360-853-8183
Mailing Address - Fax:
Practice Address - Street 1:7438 S D AVE STE A
Practice Address - Street 2:
Practice Address - City:CONCRETE
Practice Address - State:WA
Practice Address - Zip Code:98237-9642
Practice Address - Country:US
Practice Address - Phone:360-853-8183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DANIEL H & EMILY B GARCIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-29
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA33706OtherREGENCE
WA18289OtherLABOR & INDUSTRIES
WA7261100Medicaid
WAD33869Medicare UPIN
WAGAB20544Medicare ID - Type Unspecified