Healthcare Provider Details

I. General information

NPI: 1124407275
Provider Name (Legal Business Name): RON MARTIN GARCIA MENORCA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 11/20/2021
Certification Date: 11/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14139 POTOMAC MILLS RD
WOODBRIDGE VA
22192-4644
US

IV. Provider business mailing address

12918 PINTAIL RD
WOODBRIDGE VA
22192-3831
US

V. Phone/Fax

Practice location:
  • Phone: 703-490-8400
  • Fax:
Mailing address:
  • Phone: 916-479-4544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA145391
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: