Healthcare Provider Details

I. General information

NPI: 1447250089
Provider Name (Legal Business Name): JOSE LUIS GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1C 13 DON PELAYO AVE.
TOA BAJA PR
00949
US

IV. Provider business mailing address

PO BOX 607071 PMB 125
BAYAMON PR
00960-7071
US

V. Phone/Fax

Practice location:
  • Phone: 787-740-4994
  • Fax: 787-251-0539
Mailing address:
  • Phone: 787-740-4994
  • Fax: 787-251-0539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number11108
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: