Provider Demographics
NPI:1447408810
Name:GARCIA, IVAN DIEGO (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:DIEGO
Last Name: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 1:54JUAN PABLO DUARTE
Mailing Address - Street 2:FLORAL PARK APT2
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00917
Mailing Address - Country:US
Mailing Address - Phone:787-538-0132
Mailing Address - Fax:
Practice Address - Street 1:54JUAN PABLO DUARTE FLORAL PARK
Practice Address - Street 2:APARTMENT 2
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-538-0132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89894Medicare PIN