Provider Demographics
NPI:1487904835
Name:GARCIA, ZAIDALID (LMP)
Entity type:Individual
Prefix:
First Name:ZAIDALID
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1453 S 308TH ST APT 12
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4760
Mailing Address - Country:US
Mailing Address - Phone:541-272-0602
Mailing Address - Fax:
Practice Address - Street 1:417 RAMSAY WAY, SUITE 113
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4502
Practice Address - Country:US
Practice Address - Phone:253-859-0100
Practice Address - Fax:253-373-9600
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60283743225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist