Provider Demographics
NPI:1275620163
Name:GARCIA-GARCIA, GUILLERMO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:
Last Name:GARCIA-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:EMILIO R DELGADO #1235
Mailing Address - Street 2:URB CLUB MANOR
Mailing Address - City:RIOS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4345
Mailing Address - Country:US
Mailing Address - Phone:787-768-3130
Mailing Address - Fax:787-268-4054
Practice Address - Street 1:655 PAVIN ST
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-727-4923
Practice Address - Fax:787-268-4054
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2405208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2405OtherSTATE LICENSE
PR061675OtherBLUE CROSS
PR061675OtherBLUE CROSS
PR21321Medicare ID - Type Unspecified