Healthcare Provider Details

I. General information

NPI: 1487632022
Provider Name (Legal Business Name): JOSE MENNEN B GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W SAINT MARYS RD
TUCSON AZ
85745-3170
US

IV. Provider business mailing address

1310 W ST MARYS RD
TUCSON AZ
85745
US

V. Phone/Fax

Practice location:
  • Phone: 520-622-1366
  • Fax: 520-622-1384
Mailing address:
  • Phone: 520-622-1366
  • Fax: 520-622-1384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24534
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: