Healthcare Provider Details

I. General information

NPI: 1477396331
Provider Name (Legal Business Name): MARISSA GARCIA AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

7800 HEADLINE BLVD NE UNIT 1219
ALBUQUERQUE NM
87109-4599
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-3535
  • Fax:
Mailing address:
  • Phone: 505-699-7569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberSAH-2024-0220
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: