Healthcare Provider Details

I. General information

NPI: 1093706673
Provider Name (Legal Business Name): LESLIE M GARCIA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE BALDORIOTY NORTE #165 EDIFICIO CENTRAL STE 4
AIBONITO PR
00705
US

IV. Provider business mailing address

CALLE BALDORIOTY NORTE #165 EDIFICIO CENTRAL STE 4
AIBONITO PR
00705
US

V. Phone/Fax

Practice location:
  • Phone: 787-735-1974
  • Fax: 787-735-1974
Mailing address:
  • Phone: 787-735-1974
  • Fax: 787-735-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number359
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0130
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: