Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 15613 | PR |
NPI | 1023237625 |
---|---|
Provider Name | Juan R Garcia SR. |
First Address | Mayaguez, PR 00682 |
Second Address | Las Marias, PR 00670-2102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 23/01/2013 |