Healthcare Provider Details

I. General information

NPI: 1154868420
Provider Name (Legal Business Name): EVERARDO GARCIA MSN, APRN, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 02/21/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 LANG AVE NE STE 110
ALBUQUERQUE NM
87109-4475
US

IV. Provider business mailing address

4801 LANG AVE NE STE 110
ALBUQUERQUE NM
87109-4475
US

V. Phone/Fax

Practice location:
  • Phone: 505-393-7493
  • Fax: 330-578-7877
Mailing address:
  • Phone: 505-551-1994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95008494
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95022888
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: