Provider Demographics
NPI:1699747691
Name:GARIB GARCIA, LIDIA R (MD)
Entity type:Individual
Prefix:DR
First Name:LIDIA
Middle Name:R
Last Name:GARIB GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-1107
Mailing Address - Country:US
Mailing Address - Phone:787-860-1300
Mailing Address - Fax:787-863-8300
Practice Address - Street 1:410 AVE GENERAL VALERO STE 408
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3992
Practice Address - Country:US
Practice Address - Phone:787-860-1300
Practice Address - Fax:787-863-8300
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8157208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7380006OtherHUMANA HEALTH
PRP00152916OtherPALMETTO GBA
PR2-8157OtherCIGNA
PR3481OtherFIRST MEDICAL
PR6605733612OtherVA ADMINISTRATION
PR2501791OtherA.C.A.A.
PR29459OtherS.S.S.
PR358239100OtherO.W.C.P.
PR29459Medicare ID - Type Unspecified
0029459Medicare Oscar/Certification
PR7380006OtherHUMANA HEALTH