Healthcare Provider Details

I. General information

NPI: 1639596646
Provider Name (Legal Business Name): DESIREE GARCIA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 ATRISCO DR NW STE A
ALBUQUERQUE NM
87120-4902
US

IV. Provider business mailing address

3809 ATRISCO DR NW STE A
ALBUQUERQUE NM
87120-4902
US

V. Phone/Fax

Practice location:
  • Phone: 505-932-8979
  • Fax:
Mailing address:
  • Phone: 505-932-8979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: