Provider Demographics
NPI:1912984667
Name:GARCIA, CARLOS D (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:D
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:525 AVE FD ROOSEVELT
Mailing Address - Street 2:SUITE 401, LA TORRE DE PLAZA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-8001
Mailing Address - Country:US
Mailing Address - Phone:787-237-0554
Mailing Address - Fax:787-282-0472
Practice Address - Street 1:525 AVE FD ROOSEVELT
Practice Address - Street 2:SUITE 401, LA TORRE DE PLAZA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-8001
Practice Address - Country:US
Practice Address - Phone:787-237-0554
Practice Address - Fax:787-282-0472
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR11861207U00000X, 2085N0904X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR008-8851Medicare ID - Type Unspecified
PRG42142Medicare UPIN