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General NPI Number Information
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NPI Number | 1659756740
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Entity Type | Organization
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Legal Business Name | GARCIA INSTITUTE PONTE VEDRA LLC
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 09/15/2016
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Provider Practice Location Address
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Address Line | 190 A1A N # 1
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-1773
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Country | US
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Telephone | 904-686-8020
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Fax | 904-834-2592
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Provider Business Mailing Address
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Address Line | 190 A1A N # 1
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-1773
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Country | US
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Telephone | 904-686-8020
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Fax | 904-834-2592
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Authorized Official
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Title or Position | OWNER
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Name | ROBERTO GARCIA
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Credential | M.D.
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Telephone | 904-686-8020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2082S0099X
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Taxonomy Name | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
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License Number | ME86699
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License Number State | FL
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