Provider Demographics
NPI:1730772047
Name:GARCIA, PAULA MICHELLE ANNE
Entity type:Individual
Prefix:
First Name:PAULA MICHELLE ANNE
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 1:1725 S CORONADO RD APT 3152
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0092
Mailing Address - Country:US
Mailing Address - Phone:480-433-5550
Mailing Address - Fax:
Practice Address - Street 1:1606 S SIGNAL BUTTE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-1482
Practice Address - Country:US
Practice Address - Phone:480-358-9731
Practice Address - Fax:480-358-9733
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZT056738183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician