Healthcare Provider Details

I. General information

NPI: 1053556217
Provider Name (Legal Business Name): JULIO E GARCIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3289 WOODBURN RD #060
ANNANDALE VA
22003-6800
US

IV. Provider business mailing address

3289 WOODBURN RD #060
ANNANDALE VA
22003-6800
US

V. Phone/Fax

Practice location:
  • Phone: 703-698-0666
  • Fax: 703-573-6120
Mailing address:
  • Phone: 703-698-0666
  • Fax: 703-573-6120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberD0033521
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number0101050350
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: