Provider Demographics
NPI:1710246319
Name:GARCIA, ROMARICO BALOTRO (CSA)
Entity Type:Individual
Prefix:
First Name:ROMARICO
Middle Name:BALOTRO
Last Name:GARCIA
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 MAXWELL CT
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5459
Mailing Address - Country:US
Mailing Address - Phone:703-506-0725
Mailing Address - Fax:
Practice Address - Street 1:1069 W BROAD ST STE 908
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4610
Practice Address - Country:US
Practice Address - Phone:703-506-0725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2509246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant