Provider Demographics
NPI:1023000510
Name:GARCIA, DAGOBERTO JOSE JR (MD)
Entity Type:Individual
Prefix:
First Name:DAGOBERTO
Middle Name:JOSE
Last Name:GARCIA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1172 S DIXIE HWY # 500
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2918
Mailing Address - Country:US
Mailing Address - Phone:786-368-7490
Mailing Address - Fax:888-550-9326
Practice Address - Street 1:1172 S DIXIE HWY # 500
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2918
Practice Address - Country:US
Practice Address - Phone:786-368-7490
Practice Address - Fax:888-550-9326
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68347208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113551500Medicaid
27211Medicare ID - Type Unspecified