Provider Demographics
NPI:1437721941
Name:GARCIA, JAVIER
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
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 1:5850 CAMERON RUN TER APT 605
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-2721
Mailing Address - Country:US
Mailing Address - Phone:240-559-7337
Mailing Address - Fax:
Practice Address - Street 1:196 THOMAS JOHNSON DR STE 120
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4521
Practice Address - Country:US
Practice Address - Phone:240-556-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2023-11-07
Deactivation Date:2023-09-23
Deactivation Code:
Reactivation Date:2023-11-02
Provider Licenses
StateLicense IDTaxonomies
MDAC005979363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner