Provider Demographics
NPI:1205376506
Name:GARCIA WELLNESS,PA
Entity Type:Organization
Organization Name:GARCIA WELLNESS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:MISS
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:305-667-1080
Mailing Address - Street 1:4119 W 9TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7266
Mailing Address - Country:US
Mailing Address - Phone:786-370-1740
Mailing Address - Fax:
Practice Address - Street 1:4119 W 9TH LN
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7266
Practice Address - Country:US
Practice Address - Phone:786-370-1740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9303206261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1831640150OtherBLUE CROSS BLUE SHIELD