Provider Demographics
NPI:1225454036
Name:GARCIA, GILBERT R
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:R
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5854 BUCKEYE LN
Mailing Address - Street 2:APT # 9
Mailing Address - City:MENTOR ON THE LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44060-2841
Mailing Address - Country:US
Mailing Address - Phone:440-209-1380
Mailing Address - Fax:440-209-1380
Practice Address - Street 1:5854 BUCKEYE LN
Practice Address - Street 2:APT # 9
Practice Address - City:MENTOR ON THE LAKE
Practice Address - State:OH
Practice Address - Zip Code:44060-2841
Practice Address - Country:US
Practice Address - Phone:440-209-1380
Practice Address - Fax:440-209-1380
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-148723-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse