MEDICARE: MILDRED 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	207Q00000X	Family Medicine Physician	220400-1	NY

General Provider Information

NPI Number	:	1750464673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILDRED GARCIA MD

Provider Business Mailing Address
First Line	:	PO BOX 511
Second Line	:
City	:	AQUEBOGUE
State	:	NY
Zip	:	11931-0511
Country	:	US
Telephone Number	:	631-722-4400
Fax Number	:	631-722-4426

Provider Business Practice Location Address
First Line	:	31 MAIN RD
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-1953
Country	:	US
Telephone Number	:	631-722-4400
Fax Number	:	631-722-4426

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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