MEDICARE: DR. JOSE MENNEN B GARCIA MD

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	24534	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487632022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE MENNEN B GARCIA MD

Provider Business Mailing Address
First Line	:	1310 W ST MARYS RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745
Country	:	US
Telephone Number	:	520-622-1366
Fax Number	:	520-622-1384

Provider Business Practice Location Address
First Line	:	1310 W SAINT MARYS RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-3170
Country	:	US
Telephone Number	:	520-622-1366
Fax Number	:	520-622-1384

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	10/21/2011

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