Healthcare Provider Details

I. General information

NPI: 1609034065
Provider Name (Legal Business Name): JESUS ROGELIO GARCIA JACQUES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2008
Last Update Date: 02/12/2024
Certification Date: 02/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MADISON OAK DR
SAN ANTONIO TX
78258-3913
US

IV. Provider business mailing address

333 N SANTA ROSA
SAN ANTONIO TX
78207-3108
US

V. Phone/Fax

Practice location:
  • Phone: 210-297-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberR4224
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: