Healthcare Provider Details

I. General information

NPI: 1780547141
Provider Name (Legal Business Name): GREGORY JAMES GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N MAIN ST
BELEN NM
87002-3720
US

IV. Provider business mailing address

1064 VALLECITO LOOP NW
LOS LUNAS NM
87031-8968
US

V. Phone/Fax

Practice location:
  • Phone: 505-966-1000
  • Fax:
Mailing address:
  • Phone: 505-966-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSW-1064
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: