Provider Demographics
NPI:1427034537
Name:GARCIA, MARIO (MD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
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:PO BOX 1687
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602
Mailing Address - Country:US
Mailing Address - Phone:787-658-6292
Mailing Address - Fax:787-658-6272
Practice Address - Street 1:URB. VILLA ALEGRIA
Practice Address - Street 2:CALLE ZAFIRO 151 LOCAL 1B
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-658-6292
Practice Address - Fax:787-658-6272
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR111926208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2011151OtherPREFERED HEALTH PLAN
PR3111926OtherUIA
PR90002413OtherFAMILY CARE
PR22268OtherTRIPLE S
PR6030082OtherHUMANA
PR1783OtherPREFERED MEDICAL CHOICE
PR100250OtherCRUZ AZUL
0022268Medicare ID - Type Unspecified
PR22268OtherTRIPLE S
I04523Medicare UPIN