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General NPI Number Information
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NPI Number | 1508130378
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Entity Type | Individual
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Provider Name | JUAN JOSE GARCIA JR. PA-C, ATC
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Gender | Male
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Dates
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Enumeration Date | 02/26/2012
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 1650 17TH ST. NW
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City | WASHINGTON
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State | DC
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Zip | 20500
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Country | US
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Telephone | 202-814-7289
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Fax |
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Provider Business Mailing Address
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Address Line | 10719 OLD COLCHESTER RD
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City | LORTON
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State | VA
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Zip | 22079-3612
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 52298
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0110-008889
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License Number State | VA
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