Provider Demographics
NPI:1093706673
Name:GARCIA, LESLIE M (OD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:M
Last Name:GARCIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE BALDORIOTY NORTE #165
Mailing Address - Street 2:EDIFICIO CENTRAL STE 4
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:787-735-1974
Mailing Address - Fax:787-735-1974
Practice Address - Street 1:CALLE BALDORIOTY NORTE #165
Practice Address - Street 2:EDIFICIO CENTRAL STE 4
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-735-1974
Practice Address - Fax:787-735-1974
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR359152W00000X
PR0130152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7830009OtherHUMANA INSURANCE CO
890315OtherMEDICARE Y MUCHO
7830009OtherHUMANA HEALTH PLANS
05068OtherDENIS VISION
58113GAOtherTRIPLE-S
6874OtherINTERNATIONAL MEDICAL CAR
051681OtherCRUZ AZUL DE PR
23405OtherPROSSAM
6874OtherINTERNATIONAL MEDICAL CAR