MEDICARE: JULIA GARCIA MANCEBO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2080P0203X	Pediatric Critical Care Medicine Physician	W4470	TX

General Provider Information

NPI Number	:	1255026860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA GARCIA MANCEBO MD

Provider Business Mailing Address
First Line	:	1118 ROBBIE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-2950
Country	:	US
Telephone Number	:	857-701-9311
Fax Number	:

Provider Business Practice Location Address
First Line	:	6651 MAIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2351
Country	:	US
Telephone Number	:	832-826-6230
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2023
Last Update Date	:	04/07/2026

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