Basic Information
| Provider Information | |||||||||
| NPI: | 1124398847 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA SAENZ DE SICILIA | ||||||||
| FirstName: | MAURICIO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4301 W MARKHAM ST # 783 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722057101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016868000 | ||||||||
| FaxNumber: | 5015265148 | ||||||||
| Practice Location | |||||||||
| Address1: | 4301 W MARKHAM ST # 567 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722057101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016865126 | ||||||||
| FaxNumber: | 5015264596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2012 | ||||||||
| LastUpdateDate: | 06/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2020022497 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 2020022497 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | E-5052 | AR | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RT0003X | E-5052 | AR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Transplant Hepatology |
ID Information
| ID | Type | State | Issuer | Description | 200087426 | 05 | MO | MEDICAID |