Provider Demographics
NPI:1285630749
Name:GARCIA-VICARIO, JOSE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:GARCIA-VICARIO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:CONDOMINIO CONCORDIA
Mailing Address - Street 2:8129 CALLE CONCORDIA SUITE 201
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1550
Mailing Address - Country:US
Mailing Address - Phone:787-844-4170
Mailing Address - Fax:787-844-4170
Practice Address - Street 1:CONDOMINIO CONCORDIA
Practice Address - Street 2:8129 CALLE CONCORDIA SUITE 201
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1550
Practice Address - Country:US
Practice Address - Phone:787-844-4170
Practice Address - Fax:787-844-4170
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2012-08-14
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Provider Licenses
StateLicense IDTaxonomies
PR4977207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0096866Medicare PIN
D08703Medicare UPIN