Provider Demographics
NPI:1588204101
Name:GARCIA, RICARDO ANDRES
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:ANDRES
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:D1 CALLE FRONTERA STE 6
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2578
Mailing Address - Country:US
Mailing Address - Phone:787-761-7605
Mailing Address - Fax:787-755-3252
Practice Address - Street 1:D1 CALLE FRONTERA STE 6
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2578
Practice Address - Country:US
Practice Address - Phone:787-761-7605
Practice Address - Fax:787-755-3252
Is Sole Proprietor?:No
Enumeration Date:2020-01-11
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6104780Medicaid