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General NPI Number Information
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NPI Number | 1497174981
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Entity Type | Organization
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Legal Business Name | GARCIA-JUARBE MEDICAL
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 04/10/2014
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Provider Practice Location Address
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Address Line | 1473 SW 116TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-3771
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Country | US
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Telephone | 954-592-0898
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Fax |
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Provider Business Mailing Address
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Address Line | 1473 SW 116TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-3771
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Country | US
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Telephone | 954-592-0898
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IXSA TANYA GARCIA-JUARBE
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Credential | D.O, D.P.M
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Telephone | 954-592-0898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS12430
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License Number State | FL
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