Provider Demographics
NPI:1093976706
Name:GARCIA, GABRIEL (MD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:GARCIA
Suffix:
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 1:129 W LAKE MEAD PKWY
Mailing Address - Street 2:#B-18
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7055
Mailing Address - Country:US
Mailing Address - Phone:702-564-4440
Mailing Address - Fax:702-558-1522
Practice Address - Street 1:129 W LAKE MEAD PKWY
Practice Address - Street 2:#B-18
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7055
Practice Address - Country:US
Practice Address - Phone:702-564-4440
Practice Address - Fax:702-558-1522
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13286207L00000X
PAMT189571207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPENDINGMedicaid
NVPENDINGMedicaid