Basic Information
Provider Information
NPI: 1851930200
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARCIA
FirstName: HECTOR
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 13162 SW 255TH TER
Address2:  
City: HOMESTEAD
State: FL
PostalCode: 330326011
CountryCode: US
TelephoneNumber: 3059688082
FaxNumber:  
Practice Location
Address1: 1475 NW 12TH AVE
Address2:  
City: MIAMI
State: FL
PostalCode: 331361002
CountryCode: US
TelephoneNumber: 3052434860
FaxNumber: 3052439161
Other Information
ProviderEnumerationDate: 01/02/2020
LastUpdateDate: 05/20/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/20/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X11005553FLN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LF0000XAPRN11005553FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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