Healthcare Provider Details

I. General information

NPI: 1932575198
Provider Name (Legal Business Name): JULIO CESAR GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 MIX AVE
HAMDEN CT
06514-2102
US

IV. Provider business mailing address

44 VINE ST
MERIDEN CT
06451-2850
US

V. Phone/Fax

Practice location:
  • Phone: 203-285-1082
  • Fax:
Mailing address:
  • Phone: 203-886-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1601
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: