Provider Demographics
NPI:1497801476
Name:GARCIA, AVELINO A (MD)
Entity Type:Individual
Prefix:
First Name:AVELINO
Middle Name:A
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:PO BOX 2129
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-2129
Mailing Address - Country:US
Mailing Address - Phone:432-640-2491
Mailing Address - Fax:432-640-2493
Practice Address - Street 1:375 N SAM HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5051
Practice Address - Country:US
Practice Address - Phone:432-640-2491
Practice Address - Fax:432-640-2493
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5994207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX315812301Medicaid
TXTXB102149Medicare PIN