Provider Demographics
NPI:1447250089
Name:GARCIA, JOSE LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 607071
Mailing Address - Street 2:PMB 125
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-7071
Mailing Address - Country:US
Mailing Address - Phone:787-740-4994
Mailing Address - Fax:787-251-0539
Practice Address - Street 1:1C 13 DON PELAYO AVE.
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-740-4994
Practice Address - Fax:787-251-0539
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2008-04-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR11108208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11108OtherSTATE MEDICAL LICENSE
PR500359EOtherMEDICARE MUCHO MAS (MMM)
PR9490016OtherHUMANA INSURANCE
PR201725OtherPREFERRED HEALTH
PR89154OtherTRIPLE S INSURANCE
PR500359EOtherMEDICARE MUCHO MAS (MMM)
PR11108OtherSTATE MEDICAL LICENSE