Healthcare Provider Details

I. General information

NPI: 1336100668
Provider Name (Legal Business Name): YAZMIN LIZZETTE GARCIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date: 01/17/2024
Reactivation Date: 03/05/2024

III. Provider practice location address

252 CALLE SAN JORGE SUITE 406
SAN JUAN PR
00912-3310
US

IV. Provider business mailing address

500 BLVD. DEL RIO APT. 1801
HUMACAO PR
00791-4501
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-0210
  • Fax:
Mailing address:
  • Phone: 787-580-5916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12216
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: