Healthcare Provider Details

I. General information

NPI: 1962504795
Provider Name (Legal Business Name): MANUEL A GARCIA HERRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MANUEL A GARCIA HERRAN M.D.

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 NE 163RD ST
NORTH MIAMI BEACH FL
33162-4867
US

IV. Provider business mailing address

31 NE 27TH DR
WILTON MANORS FL
33334-1071
US

V. Phone/Fax

Practice location:
  • Phone: 305-882-9323
  • Fax: 786-916-2986
Mailing address:
  • Phone: 954-555-1190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME72070
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME72070
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: