Provider Demographics
NPI:1063443661
Name:GARCIA, JUAN PACHECO (MD)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:PACHECO
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1626
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77410-1626
Mailing Address - Country:US
Mailing Address - Phone:281-788-6526
Mailing Address - Fax:281-888-7790
Practice Address - Street 1:11511 VETERANS MEMORIAL DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-2603
Practice Address - Country:US
Practice Address - Phone:281-583-0806
Practice Address - Fax:206-666-3965
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH4340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE36546Medicare UPIN
TX8F3593Medicare PIN