Provider Demographics
NPI:1669810719
Name:GARCIA, JUBENAL (PTA)
Entity type:Individual
Prefix:
First Name:JUBENAL
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 E NOLANA AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6101
Mailing Address - Country:US
Mailing Address - Phone:956-630-6300
Mailing Address - Fax:956-630-3443
Practice Address - Street 1:1005 E NOLANA AVE STE C
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6101
Practice Address - Country:US
Practice Address - Phone:956-630-6300
Practice Address - Fax:956-630-3443
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2091655225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167033301Medicaid