Provider Demographics
NPI:1467801696
Name:GARCIA, JUAN RICARDO (PM)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:RICARDO
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:K5 CALLE 3
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-1602
Mailing Address - Country:US
Mailing Address - Phone:787-458-8559
Mailing Address - Fax:
Practice Address - Street 1:K5 CALLE 3
Practice Address - Street 2:URB LA MONSERRATE
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660-1602
Practice Address - Country:US
Practice Address - Phone:787-458-8559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2641146L00000X
FL529621146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic