Provider Demographics
NPI:1386069201
Name:GARCIA, MORAIMA (PHD)
Entity type:Individual
Prefix:DR
First Name:MORAIMA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 CALLE FUERTE
Mailing Address - Street 2:APT. #1 CONDOMINIO SAN JUAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3812
Mailing Address - Country:US
Mailing Address - Phone:787-632-5699
Mailing Address - Fax:
Practice Address - Street 1:350 CALLE FUERTE
Practice Address - Street 2:APT. #1 CONDOMINIO SAN JUAN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3812
Practice Address - Country:US
Practice Address - Phone:787-632-5699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4270103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical