Healthcare Provider Details

I. General information

NPI: 1528012564
Provider Name (Legal Business Name): JORGE L GARIB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E12 CALLE MALAGA VISTAMAR MARINA ESTE
CAROLINA PR
00983-1507
US

IV. Provider business mailing address

E12 CALLE MALAGA VISTAMAR MARINA ESTE
CAROLINA PR
00983-1507
US

V. Phone/Fax

Practice location:
  • Phone: 787-752-0639
  • Fax: 787-721-1684
Mailing address:
  • Phone: 787-752-0639
  • Fax: 787-721-1684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number25MA04500800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: