Healthcare Provider Details

I. General information

NPI: 1932890167
Provider Name (Legal Business Name): ELIAS GARCIA GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11510 S FORTUNA RD
YUMA AZ
85367-7886
US

IV. Provider business mailing address

2400 EMORY AVE
MCALLEN TX
78504-5788
US

V. Phone/Fax

Practice location:
  • Phone: 928-342-7046
  • Fax: 928-342-7018
Mailing address:
  • Phone: 956-562-5390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8917
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: