Provider Demographics
NPI:1003840166
Name:GARCIA, JUAN R JR (CCA)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:R
Last Name:GARCIA
Suffix:JR
Gender:
Credentials:CCA
Other - Prefix:
Other - First Name:GARCIA MEDICAL
Other - Middle Name:
Other - Last Name:ART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-500-4266
Practice Address - Street 1:601 N CAROLINE ST FL 6
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0006
Practice Address - Country:US
Practice Address - Phone:410-955-8215
Practice Address - Fax:410-955-1085
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5271320002229N00000X
224900000X, 156FX1700X, 224L00000X, 225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes229N00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersAnaplastologist
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
No156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5271320002Medicare NSC