Provider Demographics
NPI:1487632022
Name:GARCIA, JOSE MENNEN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MENNEN B
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 1:1310 W ST MARYS RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745
Mailing Address - Country:US
Mailing Address - Phone:520-622-1366
Mailing Address - Fax:520-622-1384
Practice Address - Street 1:1310 W SAINT MARYS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-3170
Practice Address - Country:US
Practice Address - Phone:520-622-1366
Practice Address - Fax:520-622-1384
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24534208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ359796Medicaid