Provider Demographics
NPI:1992004576
Name:GARCIA-HENRIQUEZ, NORBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:NORBERTO
Middle Name:
Last Name:GARCIA-HENRIQUEZ
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 1:258 S CHICKASAW TRL STE 201
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-3523
Mailing Address - Country:US
Mailing Address - Phone:407-303-6626
Mailing Address - Fax:407-303-6634
Practice Address - Street 1:258 S CHICKASAW TRL STE 201
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-3523
Practice Address - Country:US
Practice Address - Phone:407-303-6626
Practice Address - Fax:407-303-6634
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME138022208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101211600Medicaid