Provider Demographics
NPI:1245487388
Name:GARCIA, MANUEL ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:ANTONIO
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 1:1695 NW 110TH AVE
Mailing Address - Street 2:SUITE #309
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1930
Mailing Address - Country:US
Mailing Address - Phone:305-551-2828
Mailing Address - Fax:305-551-4334
Practice Address - Street 1:1695 NW 110TH AVE
Practice Address - Street 2:SUITE #309
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-1930
Practice Address - Country:US
Practice Address - Phone:305-551-2828
Practice Address - Fax:305-551-4334
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME1037392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000992400Medicaid
FLBS622YMedicare PIN
FL000992400Medicaid