Healthcare Provider Details

I. General information

NPI: 1912692310
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8518 E INDIGO ST
MESA AZ
85207-3185
US

IV. Provider business mailing address

8518 E INDIGO ST
MESA AZ
85207-3185
US

V. Phone/Fax

Practice location:
  • Phone: 480-637-8201
  • Fax:
Mailing address:
  • Phone: 480-637-8201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSUPERVISED
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberSUPERVISED
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: