Provider Demographics
NPI:1316787757
Name:GARCIA, GENESIS
Entity type:Individual
Prefix:
First Name:GENESIS
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR #3 KILOMETRO 43.3
Mailing Address - Street 2:PLAZA FAJARDO
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-860-1050
Mailing Address - Fax:787-860-1111
Practice Address - Street 1:CARR #3 KILOMETRO 43.3
Practice Address - Street 2:PLAZA FAJARDO
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-860-1050
Practice Address - Fax:787-860-1111
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1418156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician