MEDICARE: JULIO C GARCIA

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2962741	OTHER		MEXICO PROFESSIONAL LICENSE

General Provider Information

NPI Number	:	1891093688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JULIO C GARCIA

Provider Business Mailing Address
First Line	:	PO BOX 210116
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91921-0116
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2627 JM VELASCO ST. SUITE 102
Second Line	:	ZONA RIO
City	:	TIJUANA
State	:	BAJA CALIFORNIA
Zip	:	22000
Country	:	MX
Telephone Number	:	619-272-9597
Fax Number	:

Authorized Official
Title or Position	:	BILLER
Name	:	ALEJANDRO A RAMOS
Credential	:
Telephone Number	:	619-992-6290

Provider Enumeration Date	:	03/03/2011
Last Update Date	:	03/03/2011

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Directions to “JULIO C GARCIA ” Practice Location

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