Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | ME86699 | FL |
NPI | 1669552626 |
---|---|
Provider Name | Roberto Eloy Garcia |
First Address | Ponte Vedra Beach, FL 32082-1709 |
Second Address | Ponte Vedra Beach, FL 32082-1709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 22/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I45197 | (02) | FL |
U6245Y | MEDICARE PTAN (01) | FL |