Provider Demographics
NPI:1952728339
Name:GARCIA, DIEGO
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:
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 1:801 DOUGLAS AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-5206
Mailing Address - Country:US
Mailing Address - Phone:407-830-6412
Mailing Address - Fax:407-830-8413
Practice Address - Street 1:801 DOUGLAS AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-5206
Practice Address - Country:US
Practice Address - Phone:407-830-6412
Practice Address - Fax:407-830-8413
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist