Healthcare Provider Details

I. General information

NPI: 1225279250
Provider Name (Legal Business Name): CARLA M GARCIA D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 EUBANK BLVD NE STE 105
ALBUQUERQUE NM
87111-2565
US

IV. Provider business mailing address

4550 EUBANK BLVD NE STE 105
ALBUQUERQUE NM
87111-2565
US

V. Phone/Fax

Practice location:
  • Phone: 505-271-6608
  • Fax:
Mailing address:
  • Phone: 505-235-7026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number987
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: