Provider Demographics
NPI:1700139946
Name:GARCIA, JUAN ROBERTO
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:ROBERTO
Last Name:GARCIA
Suffix:
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 1:5613 114TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-6985
Mailing Address - Country:US
Mailing Address - Phone:806-515-4263
Mailing Address - Fax:806-224-2414
Practice Address - Street 1:5613 114TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-6985
Practice Address - Country:US
Practice Address - Phone:806-515-4263
Practice Address - Fax:806-224-2414
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA229814363L00000X
TXAP122729363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner