Healthcare Provider Details

I. General information

NPI: 1285184812
Provider Name (Legal Business Name): ANDY GARCIA MMS, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9532 GRIFFIN RD
COOPER CITY FL
33328-3416
US

IV. Provider business mailing address

9532 GRIFFIN RD
COOPER CITY FL
33328-3416
US

V. Phone/Fax

Practice location:
  • Phone: 786-475-2291
  • Fax:
Mailing address:
  • Phone: 786-475-2291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9114952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: