Healthcare Provider Details

I. General information

NPI: 1548576424
Provider Name (Legal Business Name): PEDRO GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 SE FOREST GLADE TRL
HOBE SOUND FL
33455-8302
US

IV. Provider business mailing address

5801 SE FOREST GLADE TRL
HOBE SOUND FL
33455-8302
US

V. Phone/Fax

Practice location:
  • Phone: 702-354-1925
  • Fax: 772-600-7066
Mailing address:
  • Phone: 702-354-1925
  • Fax: 772-600-7066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number46133
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number46977
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: