Provider Demographics
NPI:1386477321
Name:GARCIA, GARY M
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:M
Last Name:GARCIA
Suffix:
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 1:7826 NE 156TH PL
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-7143
Mailing Address - Country:US
Mailing Address - Phone:360-723-2554
Mailing Address - Fax:
Practice Address - Street 1:5197 NW LOWER RIVER RD BLDG 1
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-1013
Practice Address - Country:US
Practice Address - Phone:360-205-1222
Practice Address - Fax:360-469-1720
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist