Provider Demographics
NPI:1003816463
Name:GARCIA-MAYOL, LUIS R (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:R
Last Name:GARCIA-MAYOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:747 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 605
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2049
Mailing Address - Country:US
Mailing Address - Phone:305-445-4535
Mailing Address - Fax:305-441-1879
Practice Address - Street 1:747 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 605
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2049
Practice Address - Country:US
Practice Address - Phone:305-445-4535
Practice Address - Fax:305-441-1879
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0037831207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065186900Medicaid
FL065186900Medicaid
FL95648Medicare ID - Type Unspecified