Provider Demographics
NPI:1831888403
Name:GARCIA, DIANA RAQUEL
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:RAQUEL
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:RAQUEL
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11925 SOUTHWEST FWY STE 5
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-2300
Mailing Address - Country:US
Mailing Address - Phone:832-460-5121
Mailing Address - Fax:
Practice Address - Street 1:11925 SOUTHWEST FWY STE 5
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2300
Practice Address - Country:US
Practice Address - Phone:832-460-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician