Provider Demographics
NPI:1831409820
Name:GARCIA, JOSE LUIS
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:LUIS
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:L
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2412 E ROSARIO MISSION DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85194-9157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2412 E ROSARIO MISSION DR
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85194-9157
Practice Address - Country:US
Practice Address - Phone:520-709-1571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2670359385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child