Healthcare Provider Details

I. General information

NPI: 1316787757
Provider Name (Legal Business Name): GENESIS GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 05/31/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #3 KILOMETRO 43.3 PLAZA FAJARDO
FAJARDO PR
00738
US

IV. Provider business mailing address

CARR #3 KILOMETRO 43.3 PLAZA FAJARDO
FAJARDO PR
00738
US

V. Phone/Fax

Practice location:
  • Phone: 787-860-1050
  • Fax: 787-860-1111
Mailing address:
  • Phone: 787-860-1050
  • Fax: 787-860-1111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1418
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: