Provider Demographics
NPI:1700192762
Name:GARCIA & GARCIA MD S P A
Entity Type:Organization
Organization Name:GARCIA & GARCIA MD S P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRINIDAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-763-6427
Mailing Address - Street 1:306 NE 19TH DR
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-1911
Mailing Address - Country:US
Mailing Address - Phone:863-763-6427
Mailing Address - Fax:863-763-0096
Practice Address - Street 1:8980 S US HIGHWAY 1
Practice Address - Street 2:SUITE 106
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3482
Practice Address - Country:US
Practice Address - Phone:772-337-5595
Practice Address - Fax:863-763-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0021723207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053451000Medicaid
FL47018Medicare PIN
FLD54985Medicare UPIN