Healthcare Provider Details

I. General information

NPI: 1174641732
Provider Name (Legal Business Name): ROLANDO GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 03/07/2023
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13131 KINGS LAKE DR UNIT 101
GIBSONTON FL
33534-3959
US

IV. Provider business mailing address

13131 KINGS LAKE DR UNIT 101
GIBSONTON FL
33534-3959
US

V. Phone/Fax

Practice location:
  • Phone: 813-672-6092
  • Fax: 813-677-1892
Mailing address:
  • Phone: 813-672-6092
  • Fax: 813-677-1892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME98642
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: