Provider Demographics
NPI:1376506865
Name:GARCIA, AWILDA (MD)
Entity Type:Individual
Prefix:MS
First Name:AWILDA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
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:CALLE 2 # N 13
Mailing Address - Street 2:URB. SAN JORGE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732
Mailing Address - Country:US
Mailing Address - Phone:787-430-5233
Mailing Address - Fax:787-841-0077
Practice Address - Street 1:1034 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-1115
Practice Address - Country:US
Practice Address - Phone:787-843-9393
Practice Address - Fax:789-784-1007
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6054174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6054OtherLICENCE
PRE20098Medicare UPIN
PR27641Medicare PIN