Provider Demographics
NPI:1568762763
Name:GARCIA, RENE ARMANDO
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:ARMANDO
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 JACLIF CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4430
Mailing Address - Country:US
Mailing Address - Phone:850-999-2328
Mailing Address - Fax:850-320-6114
Practice Address - Street 1:1845 JACLIF CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4430
Practice Address - Country:US
Practice Address - Phone:850-999-2328
Practice Address - Fax:850-320-6114
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57018194207R00000X
FLME123224207R00000X, 207RN0300X
LAMD.206258208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015445900Medicaid
MS09788529Medicaid
LA2340344Medicaid