MEDICARE: COASTAL BEND PRIMARY CARE CORP

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	207Q00000X	Family Medicine Physician
2	207Q00000X	Family Medicine Physician	L8345	TX

General Provider Information

NPI Number	:	1639408974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL BEND PRIMARY CARE CORP

Provider Business Mailing Address
First Line	:	4621 S STAPLES
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-2605
Country	:	US
Telephone Number	:	361-654-0050
Fax Number	:	361-654-0056

Provider Business Practice Location Address
First Line	:	4621 S STAPLES
Second Line	:	SUITE A
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-2605
Country	:	US
Telephone Number	:	361-654-0050
Fax Number	:	361-654-0056

Authorized Official
Title or Position	:	OWNER/MD
Name	:	JESSE G GARCIA
Credential	:	M.D.
Telephone Number	:	361-654-0050

Provider Enumeration Date	:	12/16/2009
Last Update Date	:	06/14/2011

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Directions to “COASTAL BEND PRIMARY CARE CORP ” Practice Location

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