Healthcare Provider Details

I. General information

NPI: 1306847876
Provider Name (Legal Business Name): EDWINA CHRISTINE GARCIA P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. EDWINA CHRISTINE GRIEGO

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 LANG AVE NE
ALBUQUERQUE NM
87109-4397
US

IV. Provider business mailing address

4901 LANG AVE NE
ALBUQUERQUE NM
87109-4397
US

V. Phone/Fax

Practice location:
  • Phone: 505-842-8171
  • Fax: 505-246-0684
Mailing address:
  • Phone: 505-842-8171
  • Fax: 505-246-0684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2004-0057
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: