Provider Demographics
NPI:1366569055
Name:LUIS R. GARCIA-MAYOL, MD PA
Entity type:Organization
Organization Name:LUIS R. GARCIA-MAYOL, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:GARCIA MAYOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-445-4535
Mailing Address - Street 1:747 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 605
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2049
Mailing Address - Country:US
Mailing Address - Phone:305-445-4535
Mailing Address - Fax:305-441-1879
Practice Address - Street 1:747 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 605
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2049
Practice Address - Country:US
Practice Address - Phone:305-445-4535
Practice Address - Fax:305-441-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037831207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
95648OtherBLUE CROSS/ BLUE SHIELD
FL065186900Medicaid
FL065186900Medicaid