Provider Demographics
NPI:1699981340
Name:GARCIA, NELSON A
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:A
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC-05 BOX 11449
Mailing Address - Street 2:CARR 568 KM 25.6
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-9800
Mailing Address - Country:US
Mailing Address - Phone:787-859-4982
Mailing Address - Fax:787-859-8128
Practice Address - Street 1:HC-05 BOX 10126 BO. PADILLA
Practice Address - Street 2:CARR 159 KM 8.4
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-9800
Practice Address - Country:US
Practice Address - Phone:787-859-7959
Practice Address - Fax:787-859-8128
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3438183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician