Provider Demographics
NPI:1710052576
Name:GARCIA, GUILLERMO EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:EDUARDO
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:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-4488
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:8934 CONROY WINDERMERE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3128
Practice Address - Country:US
Practice Address - Phone:407-351-0082
Practice Address - Fax:407-374-1637
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31088208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038172100Medicaid
FL3026OtherHUMANA CENTER #
FL038172100Medicaid
FL4008383OtherAETNA PROVIDER ID
FL47309OtherBLUE CROSS
592995143OtherTAX ID #