1235450107 NPI number — DR. JESUS G. GARCIA, MD, PA

Table of content: (NPI 1235450107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235450107 NPI number — DR. JESUS G. GARCIA, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. JESUS G. GARCIA, MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1235450107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4423 NW LOOP 410 STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-5167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-224-8374
Provider Business Mailing Address Fax Number:
210-224-1229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4423 NW LOOP 410 STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-224-8374
Provider Business Practice Location Address Fax Number:
210-224-1229
Provider Enumeration Date:
06/15/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
JESUS
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
210-224-8374

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  E5757 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RE0101X , with the licence number: E5757 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X , with the licence number: E5757 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: E5757 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00AL81 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".