Healthcare Provider Details

I. General information

NPI: 1477200624
Provider Name (Legal Business Name): AMY GARCIA MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 LEAD AVE SE
ALBUQUERQUE NM
87102-4536
US

IV. Provider business mailing address

881 LEAD AVE SE
ALBUQUERQUE NM
87102-4536
US

V. Phone/Fax

Practice location:
  • Phone: 505-395-9234
  • Fax: 505-365-7129
Mailing address:
  • Phone: 505-395-9234
  • Fax: 505-365-7129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AMY GARCIA
Title or Position: OWNER
Credential: MD
Phone: 505-730-1717