Healthcare Provider Details

I. General information

NPI: 1306739453
Provider Name (Legal Business Name): TONI RAE GARCIA MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 UNIVERSITY BLVD SE
ALBUQUERQUE NM
87106-4788
US

IV. Provider business mailing address

2424 WISCONSIN ST NE
ALBUQUERQUE NM
87110-3752
US

V. Phone/Fax

Practice location:
  • Phone: 505-925-5540
  • Fax:
Mailing address:
  • Phone: 505-870-3239
  • Fax: 505-870-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT22026
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: