Healthcare Provider Details

I. General information

NPI: 1912533837
Provider Name (Legal Business Name): AMANDA ALYSSA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S HOUGHTON RD
TUCSON AZ
85748-7632
US

IV. Provider business mailing address

4112 GERANIUM AVE
MCALLEN TX
78501-3442
US

V. Phone/Fax

Practice location:
  • Phone: 205-436-1005
  • Fax:
Mailing address:
  • Phone: 956-648-2343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1117393
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number260897
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: