Healthcare Provider Details

I. General information

NPI: 1639107642
Provider Name (Legal Business Name): VICENTE R GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 OLD NEW MILFORD RD SUITE 2D
BROOKFIELD CT
06804-2426
US

IV. Provider business mailing address

2 OLD NEW MILFORD RD SUITE 2D
BROOKFIELD CT
06804-2426
US

V. Phone/Fax

Practice location:
  • Phone: 203-489-5437
  • Fax: 203-489-5430
Mailing address:
  • Phone: 203-489-5437
  • Fax: 203-489-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number039448
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: