Basic Information
| Provider Information | |||||||||
| NPI: | 1215495072 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | GABRIEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 955 SW 87TH CT | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331743240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863156557 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10300 SW 72ND ST STE 114 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331733038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055085580 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2019 | ||||||||
| LastUpdateDate: | 11/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | N | Technologists, Technicians & Other Technical Service Providers | Technician, Other | 106S00000X | RBT19105792 | FL | Y |
No ID Information.