Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 46917 | FL |
NPI | 1104850692 |
---|---|
Provider Name | Dr. Roberto Garcia |
First Address | Tampa, FL 33685-2186 |
Second Address | Tampa, FL 33626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 27/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
083117 | AVMED (01) | FL |
1727572 | CIGNA (01) | FL |
2051099 | AETNA (01) | FL |
261980600 | (05) | FL |
30869 | BLUE CROSS BLUE SHIELD (01) | FL |
38518 | BLUE CROSS GROUP (01) | FL |
59-3541427 | TAX IDENTIFICATION (01) | FL |
D19856 | (02) | FL |