Provider Demographics
NPI:1013469535
Name:GARCIA BANGO CHABAU, JORGE ARTURO SR
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:ARTURO
Last Name:GARCIA BANGO CHABAU
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17000 N BAY RD APT 1007
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4278
Mailing Address - Country:US
Mailing Address - Phone:786-454-7237
Mailing Address - Fax:
Practice Address - Street 1:17000 N BAY RD APT 1007
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4278
Practice Address - Country:US
Practice Address - Phone:786-454-7237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16-665246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant