Basic Information
| Provider Information | |||||||||
| NPI: | 1659477362 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | JAIME | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7330 SAN PEDRO AVE | ||||||||
| Address2: | STE. 405 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782166235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103442673 | ||||||||
| FaxNumber: | 2103442649 | ||||||||
| Practice Location | |||||||||
| Address1: | 7330 SAN PEDRO AVE | ||||||||
| Address2: | STE. 405 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782166235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103442673 | ||||||||
| FaxNumber: | 2103442649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 02/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | H7418 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | H7418 | TX | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | H7418 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1400483-25 | 05 | TX | MEDICAID |