Healthcare Provider Details

I. General information

NPI: 1205588910
Provider Name (Legal Business Name): JOSE R GARCIA RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 N SHUERBACH RD
MISSION TX
78572
US

IV. Provider business mailing address

6860 PALO AZUL DR
BROWNSVILLE TX
78526-3054
US

V. Phone/Fax

Practice location:
  • Phone: 956-264-2002
  • Fax:
Mailing address:
  • Phone: 956-517-8491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License NumberRCP00071433
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: