MEDICARE: CARLOS GARCIA FAJARDO M.D.

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	207Q00000X	Family Medicine Physician	Q6014	TX

General Provider Information

NPI Number	:	1568859742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS GARCIA FAJARDO M.D.

Provider Business Mailing Address
First Line	:	720 PLEASANTON RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214-1306
Country	:	US
Telephone Number	:	210-921-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3520 S NEW BRAUNFELS AVE
Second Line	:	STE. 106A
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-1404
Country	:	US
Telephone Number	:	210-921-3800
Fax Number	:	210-334-2851

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

Provider Enumeration Date	:	04/24/2015
Last Update Date	:	06/16/2016

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