Provider Demographics
NPI:1972348977
Name:MCLEOD-GARCIA, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MCLEOD-GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 MOONSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-6541
Mailing Address - Country:US
Mailing Address - Phone:210-473-6165
Mailing Address - Fax:512-866-9612
Practice Address - Street 1:246 MOONSTONE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-6541
Practice Address - Country:US
Practice Address - Phone:210-473-6165
Practice Address - Fax:512-866-9612
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16769172V00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty