Healthcare Provider Details

I. General information

NPI: 1386262988
Provider Name (Legal Business Name): VICENTE GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 05/27/2024
Certification Date: 05/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3118 SEVEN TREES DR
CORPUS CHRISTI TX
78410-2422
US

IV. Provider business mailing address

3118 SEVEN TREES DR
CORPUS CHRISTI TX
78410-2422
US

V. Phone/Fax

Practice location:
  • Phone: 361-425-7027
  • Fax:
Mailing address:
  • Phone: 361-425-7027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number177944
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: