Healthcare Provider Details

I. General information

NPI: 1114100898
Provider Name (Legal Business Name): OMAR GARCIA M.D, M.P.H
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4104 W LINEBAUGH AVE
TAMPA FL
33624-5239
US

IV. Provider business mailing address

13449 CANOPY CREEK DR
TAMPA FL
33625-5915
US

V. Phone/Fax

Practice location:
  • Phone: 813-333-2226
  • Fax:
Mailing address:
  • Phone: 352-369-0104
  • Fax: 352-369-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number238.000173
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number036.124389
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberME 127962
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberC1-0011674
License Number StateDE
# 5
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number35.127094
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: