Provider Demographics
NPI:1629468145
Name:GARCIA, JONATHAN L (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:L
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:AVENIDA REYNA 17
Mailing Address - Street 2:FRACCIONAMIENTO LA ALTEZA
Mailing Address - City:NAUCALPAN
Mailing Address - State:ESTADO DE MEXICO
Mailing Address - Zip Code:53116
Mailing Address - Country:MX
Mailing Address - Phone:52555-393-7764
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA REYNA 17
Practice Address - Street 2:FRACCIONAMIENTO LA ALTEZA
Practice Address - City:NAUCALPAN
Practice Address - State:ESTADO DE MEXICO
Practice Address - Zip Code:53116
Practice Address - Country:MX
Practice Address - Phone:52555-393-7764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program