Healthcare Provider Details

I. General information

NPI: 1285630749
Provider Name (Legal Business Name): JOSE A GARCIA-VICARIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONDOMINIO CONCORDIA 8129 CALLE CONCORDIA SUITE 201
PONCE PR
00717-1550
US

IV. Provider business mailing address

CONDOMINIO CONCORDIA 8129 CALLE CONCORDIA SUITE 201
PONCE PR
00717-1550
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-4170
  • Fax: 787-844-4170
Mailing address:
  • Phone: 787-844-4170
  • Fax: 787-844-4170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number4977
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: