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General NPI Number Information
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NPI Number | 1679848253
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Entity Type | Organization
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Legal Business Name | JUAN GARCIA MD PA
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Dates
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Enumeration Date | 03/15/2012
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 2401 W WALL ST
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City | MIDLAND
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State | TX
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Zip | 79701-6315
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Country | US
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Telephone | 432-682-0652
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Fax | 432-682-8081
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Provider Business Mailing Address
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Address Line | PO BOX 4170
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City | MIDLAND
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State | TX
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Zip | 79704-4170
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Country | US
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Telephone | 432-682-0652
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Fax | 432-682-8081
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Authorized Official
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Title or Position | OWNER / PHYSICIAN
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Name | JUAN GARCIA
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Credential | MD PA
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Telephone | 432-682-0652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | F5914
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License Number State | TX
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