MEDICARE: MR. JESSE GARCIA MSED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator	1729043	NY

General Provider Information

NPI Number	:	1003164351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JESSE GARCIA MSED

Provider Business Mailing Address
First Line	:	130 VOIGHT AVE
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-1538
Country	:	US
Telephone Number	:	347-432-1164
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 VOIGHT AVE
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-1538
Country	:	US
Telephone Number	:	347-432-1164
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2012
Last Update Date	:	08/16/2012

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