Provider Demographics
NPI:1467779579
Name:GARCIA, NESTOR SAMUEL (MD)
Entity type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:SAMUEL
Last Name:GARCIA
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:NESTOR
Other - Middle Name:SAMUEL
Other - Last Name:GARCIA CEBALLOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33836-0878
Mailing Address - Country:US
Mailing Address - Phone:689-223-3898
Mailing Address - Fax:689-223-3898
Practice Address - Street 1:17075 CAGAN RIDGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-9619
Practice Address - Country:US
Practice Address - Phone:863-588-4775
Practice Address - Fax:863-422-7664
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17894208D00000X
FLACN667208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN667OtherFLORIDA STATE
PR17894OtherPUERTO RICO LICENSE