Healthcare Provider Details

I. General information

NPI: 1639193436
Provider Name (Legal Business Name): MICHAEL LEON GARCIA R.N., L.M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MICHAEL GARCIA

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4642 SAN JUAN AVE
JACKSONVILLE FL
32210-3228
US

IV. Provider business mailing address

7023 SHADY PINE ST W
JACKSONVILLE FL
32244-4537
US

V. Phone/Fax

Practice location:
  • Phone: 904-389-9117
  • Fax:
Mailing address:
  • Phone: 904-778-2433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA21545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: