Provider Demographics
NPI:1740673425
Name:PABLO GARCIA JR MD
Entity type:Organization
Organization Name:PABLO GARCIA JR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:386-677-5600
Mailing Address - Street 1:PO BOX 731869
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32173-1869
Mailing Address - Country:US
Mailing Address - Phone:386-677-5600
Mailing Address - Fax:386-677-5686
Practice Address - Street 1:290 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE A-1
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8130
Practice Address - Country:US
Practice Address - Phone:386-677-5600
Practice Address - Fax:386-677-5686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55445261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371266401Medicaid
FLD31256Medicare UPIN
FL11615CMedicare PIN