Provider Demographics
NPI:1023441003
Name:GARCIA, MIREYA
Entity type:Individual
Prefix:
First Name:MIREYA
Middle Name:
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 1:351 N SAM HOUSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-4656
Mailing Address - Country:US
Mailing Address - Phone:956-399-2443
Mailing Address - Fax:956-335-4840
Practice Address - Street 1:351 N SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-4656
Practice Address - Country:US
Practice Address - Phone:956-399-2443
Practice Address - Fax:956-335-4840
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08404363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant