Provider Demographics
NPI:1902969603
Name:GARCIA, ANGEL MARTY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:MARTY
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10191 W SAMPLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3961
Mailing Address - Country:US
Mailing Address - Phone:954-906-5044
Mailing Address - Fax:800-928-7109
Practice Address - Street 1:10191 W SAMPLE RD STE 101
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3961
Practice Address - Country:US
Practice Address - Phone:954-906-5044
Practice Address - Fax:800-928-7109
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251305600Medicaid
FL251305600Medicaid
FL61336YMedicare PIN
FL61336Medicare PIN