Provider Demographics
NPI:1548530017
Name:GARCIA, PAULA R (RN)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:R
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:R
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REG PSYCHOTHERAPIST
Mailing Address - Street 1:172 JUSTICE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-9354
Mailing Address - Country:US
Mailing Address - Phone:719-275-1626
Mailing Address - Fax:719-275-4328
Practice Address - Street 1:172 JUSTICE CENTER RD
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-9354
Practice Address - Country:US
Practice Address - Phone:719-275-1626
Practice Address - Fax:719-275-4328
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC-11455101Y00000X
CORN-170048163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No101Y00000XBehavioral Health & Social Service ProvidersCounselor