Healthcare Provider Details

I. General information

NPI: 1205038437
Provider Name (Legal Business Name): ALEXIS JAVIER GARCIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 04/05/2021
Certification Date: 03/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1829 CALLE ALCAZAR URB. ALHAMBRA
PONCE PR
00716-3831
US

IV. Provider business mailing address

1829 CALLE ALCAZAR URB. ALHAMBRA
PONCE PR
00716-3831
US

V. Phone/Fax

Practice location:
  • Phone: 787-604-9396
  • Fax:
Mailing address:
  • Phone: 787-604-9396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12974
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: