Provider Demographics
NPI:1992319503
Name:GARCIA, DIANA MARISOL
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:MARISOL
Last Name: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 1:24515 SPLIT RAIL RDG
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-5064
Mailing Address - Country:US
Mailing Address - Phone:281-216-5227
Mailing Address - Fax:
Practice Address - Street 1:2108 N FRAZIER ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1220
Practice Address - Country:US
Practice Address - Phone:936-756-1435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist