Healthcare Provider Details

I. General information

NPI: 1528659422
Provider Name (Legal Business Name): RENE GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 CA. TANCA
SAN JUAN PR
00901
US

IV. Provider business mailing address

23 URB. VALLE ESCONDIDO CALLE 8 G7
GUAYNABO PR
00971
US

V. Phone/Fax

Practice location:
  • Phone: 787-725-6500
  • Fax:
Mailing address:
  • Phone: 939-630-6690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: