Healthcare Provider Details

I. General information

NPI: 1740102391
Provider Name (Legal Business Name): JEREMIAH GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 WOOD DUCK DR SW
ALBUQUERQUE NM
87121-8647
US

IV. Provider business mailing address

935 WOOD DUCK DR SW
ALBUQUERQUE NM
87121-8647
US

V. Phone/Fax

Practice location:
  • Phone: 575-910-9100
  • Fax: 575-910-9100
Mailing address:
  • Phone: 575-910-9100
  • Fax: 575-910-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: