Provider Demographics
NPI:1467660902
Name:GARCIA J DESOUSA MD PA
Entity Type:Organization
Organization Name:GARCIA J DESOUSA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARCIA
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:DESOUSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-341-1333
Mailing Address - Street 1:3334 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1539
Mailing Address - Country:US
Mailing Address - Phone:727-341-1333
Mailing Address - Fax:727-347-8675
Practice Address - Street 1:3334 66TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1539
Practice Address - Country:US
Practice Address - Phone:727-341-1333
Practice Address - Fax:727-347-8675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI640Medicare PIN