Healthcare Provider Details

I. General information

NPI: 1619778065
Provider Name (Legal Business Name): JOSELIN ANGELICA GARCIA MOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 GRANT ST
ANTHONY NM
88021-7353
US

IV. Provider business mailing address

PO BOX 321
ANTHONY NM
88021-0321
US

V. Phone/Fax

Practice location:
  • Phone: 915-243-9562
  • Fax:
Mailing address:
  • Phone: 915-243-9562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number021644
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: