Provider Demographics
NPI:1144052424
Name:GARCIA, ELLOYTHA A (CHW)
Entity type:Individual
Prefix:MS
First Name:ELLOYTHA
Middle Name:A
Last Name:GARCIA
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:MS
Other - First Name:ELLOYTHA
Other - Middle Name:A
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHW
Mailing Address - Street 1:PO BOX 201464
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-1464
Mailing Address - Country:US
Mailing Address - Phone:817-704-8830
Mailing Address - Fax:
Practice Address - Street 1:607 N OAK ST APT A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-8604
Practice Address - Country:US
Practice Address - Phone:817-704-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12888172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker