Basic Information
| Provider Information | |||||||||
| NPI: | 1871174896 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | MARIO | ||||||||
| MiddleName: | ANTONIO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6205 WALNUT GROVE ROAD | ||||||||
| Address2: | SUITE 417 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012261358 | ||||||||
| FaxNumber: | 9012261351 | ||||||||
| Practice Location | |||||||||
| Address1: | 6205 WALNUT GROVE ROAD | ||||||||
| Address2: | SUITE 417 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012261358 | ||||||||
| FaxNumber: | 9012261351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2021 | ||||||||
| LastUpdateDate: | 04/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.