Healthcare Provider Details

I. General information

NPI: 1639782253
Provider Name (Legal Business Name): JUSTIN GARCIA L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6622 N 91ST AVE STE 230
GLENDALE AZ
85305-2570
US

IV. Provider business mailing address

5445 DTC PKWY STE 1130
GREENWOOD VILLAGE CO
80111-3038
US

V. Phone/Fax

Practice location:
  • Phone: 602-325-2024
  • Fax: 720-925-5897
Mailing address:
  • Phone: 720-749-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18825
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLAC-012235
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: