MEDICARE: DR. ODETTE M GARCIA M.D.

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	208000000X	Pediatrics Physician	7365	PR

General Provider Information

NPI Number	:	1053382556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ODETTE M GARCIA M.D.

Provider Business Mailing Address
First Line	:	1029 CALLE TEGUCIGALPA
Second Line	:	LAS AMERICAS
City	:	SAN JUAN
State	:	PR
Zip	:	00921-2345
Country	:	US
Telephone Number	:	787-754-8327
Fax Number	:

Provider Business Practice Location Address
First Line	:	LAUREL PLZ
Second Line	:	PEDIATRIC INMUNOLOGY CLINIC #100 LAUREL AVE
City	:	BAYAMON
State	:	PR
Zip	:	00956-3273
Country	:	US
Telephone Number	:	787-786-6940
Fax Number	:	787-786-6940

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	07/08/2007

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