Provider Demographics
NPI:1316986995
Name:GARCIA, RENE J (MD)
Entity type:Individual
Prefix:DR
First Name:RENE
Middle Name:J
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10260 SW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7001
Mailing Address - Country:US
Mailing Address - Phone:305-596-1433
Mailing Address - Fax:305-596-7375
Practice Address - Street 1:10260 SW 56TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7001
Practice Address - Country:US
Practice Address - Phone:305-596-1433
Practice Address - Fax:305-596-7375
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0038590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD78936Medicare UPIN