Provider Demographics
NPI:1639193436
Name:GARCIA, MICHAEL LEON (RN, LMT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEON
Last Name:GARCIA
Suffix:
Gender:M
Credentials:RN, LMT
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7023 SHADY PINE ST W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-4537
Mailing Address - Country:US
Mailing Address - Phone:904-778-2433
Mailing Address - Fax:
Practice Address - Street 1:4642 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-3228
Practice Address - Country:US
Practice Address - Phone:904-389-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA21545225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist