Provider Demographics
NPI:1336543206
Name:GARCIA, ANDRES III
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name:GARCIA
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8706 TEXAS RANGER AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7200
Mailing Address - Country:US
Mailing Address - Phone:702-686-8090
Mailing Address - Fax:
Practice Address - Street 1:8708 TEXAS RANGER AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7200
Practice Address - Country:US
Practice Address - Phone:702-686-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV104100000XMedicaid