Healthcare Provider Details

I. General information

NPI: 1023219763
Provider Name (Legal Business Name): JORGE LUIS GARCIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 11/28/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 W 16TH AVE STE 100
HIALEAH FL
33012-7192
US

IV. Provider business mailing address

1442 SW 118TH CT
MIAMI FL
33184
US

V. Phone/Fax

Practice location:
  • Phone: 305-558-8687
  • Fax: 305-558-8097
Mailing address:
  • Phone: 305-282-6035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN394
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number55147-20
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME133231
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME133231
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: