Provider Demographics
NPI:1639238413
Name:GARCIA OCONNOR, HORACIO (PA)
Entity Type:Individual
Prefix:
First Name:HORACIO
Middle Name:
Last Name:GARCIA OCONNOR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8121 BERMUDA POINT LN
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3023
Mailing Address - Country:US
Mailing Address - Phone:954-475-4615
Mailing Address - Fax:
Practice Address - Street 1:8121 BERMUDA POINT LN
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3023
Practice Address - Country:US
Practice Address - Phone:954-475-4615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100799363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290871900Medicaid
FLP41933Medicare UPIN
FLE6378ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER