1104850692 NPI number — DR. ROBERTO GARCIA M.D.

Table of content: DR. ROBERTO GARCIA M.D. (NPI 1104850692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104850692 NPI number — DR. ROBERTO GARCIA M.D.

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARCIA
Provider Other First Name:
ROBERTO
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1104850692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 262186
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33685-2186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-926-4058
Provider Business Mailing Address Fax Number:
813-926-9872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10940 SHELDON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-926-4058
Provider Business Practice Location Address Fax Number:
813-926-9872
Provider Enumeration Date:
07/10/2006

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: 207K00000X , with the licence number:  46917 , 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: 263128800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30869 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 38518 . This is a "BLUE CROSS GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 083117 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 261980600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1727572 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2051099 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 59-3541427 . This is a "TAX IDENTIFICATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 261980600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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