Healthcare Provider Details

I. General information

NPI: 1154187342
Provider Name (Legal Business Name): MS. KATRINA ELYS GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10524 E HIGHWAY 92
HEREFORD AZ
85615-8371
US

IV. Provider business mailing address

PO BOX 337
DOUGLAS AZ
85608-0337
US

V. Phone/Fax

Practice location:
  • Phone: 520-366-0300
  • Fax: 520-366-0400
Mailing address:
  • Phone: 602-733-4194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11862
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: