Healthcare Provider Details

I. General information

NPI: 1124185681
Provider Name (Legal Business Name): JESSE PATRICK GARCIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: METROPOLITAN VASCULAR ACCESS ENTITY 2 NAME

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 05/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 IRVING ST NW POB SOUTH 408
WASHINGTON DC
20010-2927
US

IV. Provider business mailing address

5139 BRAWNER PL
ALEXANDRIA VA
22304-8705
US

V. Phone/Fax

Practice location:
  • Phone: 202-531-3630
  • Fax: 949-798-6963
Mailing address:
  • Phone: 202-531-3630
  • Fax: 949-798-6963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberD0064528
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD035947
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: