Healthcare Provider Details

I. General information

NPI: 1699738104
Provider Name (Legal Business Name): MIGUEL A ELIZA GARCIA 5396
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE DE DIEGO 371
RIO PIEDRAS PR
00918
US

IV. Provider business mailing address

14 CARR 833 CIMA DE TORRIMAR 1404
GUAYNABO PR
00969-7401
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-0102
  • Fax: 787-767-1899
Mailing address:
  • Phone: 787-767-0102
  • Fax: 787-767-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number05396
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: