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Provider Information for 1801536198


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JORGE ENRIQUE GARCIA Jr. Ph.D., M.S.


Sex: Male

NPI: 1801536198
Last Updated: 2022-04-01
Certification Date: 2022-04-01

Details

NameValue
NPI1801536198
Enumeration Date2022-04-01
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 101 HUNTING LODGE DR FL 33166101
MIAMI SPRINGS, FL 33166-5109
United States

Phone: 786-208-8619 | Fax:
 
Primary Practice Address 101 HUNTING LODGE DR FL 33166101
MIAMI SPRINGS, FL 33166-5109
United States

Phone: 786-208-8619 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDFL109803200
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental HealthFL5142