MEDICARE: DR. JUAN GARCIA PH.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	103T00000X	Psychologist	0575	NV

General Provider Information

NPI Number	:	1811228760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN GARCIA PH.D.

Provider Business Mailing Address
First Line	:	10043 SAND KEY ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-4858
Country	:	US
Telephone Number	:	702-291-8364
Fax Number	:

Provider Business Practice Location Address
First Line	:	3595 S TOWN CENTER DR
Second Line	:	SUITE 116
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-3019
Country	:	US
Telephone Number	:	702-291-8364
Fax Number	:	702-446-6787

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

Provider Enumeration Date	:	01/15/2010
Last Update Date	:	04/22/2010

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