1174641732 NPI number — DR. ROLANDO GARCIA MD

Table of content: DR. ROLANDO GARCIA MD (NPI 1174641732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174641732 NPI number — DR. ROLANDO GARCIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA
Provider First Name:
ROLANDO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174641732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13131 KINGS LAKE DR UNIT 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIBSONTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33534-3959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-672-6092
Provider Business Mailing Address Fax Number:
813-677-1892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13131 KINGS LAKE DR UNIT 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GIBSONTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33534-3959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-672-6092
Provider Business Practice Location Address Fax Number:
813-677-1892
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  ME98642 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 208910483 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5019130 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02131 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 279991000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: ME98642 . This is a "FLORIDA MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 12-07507 . This is a "UNITED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: ME98642 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 336427 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 004092500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9826103 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: LL1705 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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