Provider Demographics
NPI:1992707665
Name:GARCIA, SANDRA PATRICIA
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:PATRICIA
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 1:933 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-4507
Mailing Address - Country:US
Mailing Address - Phone:718-542-0472
Mailing Address - Fax:
Practice Address - Street 1:933 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-4507
Practice Address - Country:US
Practice Address - Phone:718-542-0472
Practice Address - Fax:718-709-7652
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN496005534213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01977848Medicaid
NY01977848Medicaid
04652AMedicare ID - Type Unspecified