Healthcare Provider Details

I. General information

NPI: 1235161225
Provider Name (Legal Business Name): JOHN GARCIA JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 W LAKE HOUSTON PKWY
KINGWOOD TX
77339-5222
US

IV. Provider business mailing address

2601 W LAKE HOUSTON PKWY
KINGWOOD TX
77339-5222
US

V. Phone/Fax

Practice location:
  • Phone: 281-360-7502
  • Fax: 281-360-0587
Mailing address:
  • Phone: 281-360-7502
  • Fax: 281-360-0587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 01536
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: