Healthcare Provider Details

I. General information

NPI: 1477363513
Provider Name (Legal Business Name): AMANDA GARCIA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 E BELL RD
PHOENIX AZ
85032-2112
US

IV. Provider business mailing address

1732 ALCALA DR
SANTA MARIA CA
93454-3429
US

V. Phone/Fax

Practice location:
  • Phone: 602-923-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number152235
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: