Provider Demographics
NPI:1164581344
Name:GARCIA, JUAN E (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:E
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:PO BOX 6909
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-5909
Mailing Address - Country:US
Mailing Address - Phone:787-251-8661
Mailing Address - Fax:
Practice Address - Street 1:AA3 AVE DON PELAYO
Practice Address - Street 2:URB. COVADONGA
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-5388
Practice Address - Country:US
Practice Address - Phone:787-251-8661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2016-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6841207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR28138Medicare ID - Type Unspecified
PRD08446Medicare UPIN