Provider Demographics
NPI:1750587762
Name:JOSE A GARCIA VICARIO MD CSP
Entity type:Organization
Organization Name:JOSE A GARCIA VICARIO MD CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-844-4170
Mailing Address - Street 1:CONDOMINIO CONCORDIA 8129 CALLE CONCORDIA
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1550
Mailing Address - Country:US
Mailing Address - Phone:787-844-4170
Mailing Address - Fax:787-844-4170
Practice Address - Street 1:CONDOMINIO CONCORDIA 8129 CALLE CONCORDIA
Practice Address - Street 2:SUITE 201
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1550
Practice Address - Country:US
Practice Address - Phone:787-844-4170
Practice Address - Fax:787-844-4170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4977174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDO8703Medicare UPIN
PR0096866Medicare ID - Type Unspecified