Healthcare Provider Details

I. General information

NPI: 1275446098
Provider Name (Legal Business Name): JOHNNY GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 BRIARGATE PKWY
COLORADO SPRINGS CO
80920-7804
US

IV. Provider business mailing address

4125 BRIARGATE PKWY
COLORADO SPRINGS CO
80920-7804
US

V. Phone/Fax

Practice location:
  • Phone: 719-305-9070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN.1692198
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: