Healthcare Provider Details

I. General information

NPI: 1073801593
Provider Name (Legal Business Name): JUAN CARLOS GARCIA MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SW 1 ST
MIAMI FL
33135-1964
US

IV. Provider business mailing address

1800 SW 1 ST
MIAMI FL
33135-1964
US

V. Phone/Fax

Practice location:
  • Phone: 786-360-2549
  • Fax: 786-360-4380
Mailing address:
  • Phone: 786-360-2549
  • Fax: 786-360-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA 62234
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: