MEDICARE: MIRIAM GARCIA M.T.

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	246Z00000X	Other Specialist/Technologist	3149	PR

General Provider Information

NPI Number	:	1477690048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM GARCIA M.T.

Provider Business Mailing Address
First Line	:	PO BOX 21394
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00928-1394
Country	:	US
Telephone Number	:	787-765-6069
Fax Number	:	787-765-6069

Provider Business Practice Location Address
First Line	:	112 CALLE ARZUAGA
Second Line	:	SUITE 905
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00925-3321
Country	:	US
Telephone Number	:	787-765-6069
Fax Number	:	787-765-6069

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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