Provider Demographics
NPI:1003164351
Name:GARCIA, JESSE (MSED)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:MR
Other - First Name:JESSE
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSED
Mailing Address - Street 1:130 VOIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1538
Mailing Address - Country:US
Mailing Address - Phone:347-432-1164
Mailing Address - Fax:
Practice Address - Street 1:130 VOIGHT AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1538
Practice Address - Country:US
Practice Address - Phone:347-432-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1729043174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator