Provider Demographics
NPI:1164521167
Name:GARCIA, LEON P (MD)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:P
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LEON
Other - Middle Name:P
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:94 307 FARRINGTON HWY
Mailing Address - Street 2:B 6
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797
Mailing Address - Country:US
Mailing Address - Phone:808-671-9433
Mailing Address - Fax:808-677-5455
Practice Address - Street 1:94 307 FARRINGTON HWY
Practice Address - Street 2:B 6
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797
Practice Address - Country:US
Practice Address - Phone:808-671-9433
Practice Address - Fax:808-677-5455
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIME5233207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA64988OtherBLUE CROSS BLUE SHIELD
HI05652801Medicaid
HIH0000BDRQGMedicare ID - Type Unspecified
HIA64988OtherBLUE CROSS BLUE SHIELD