Healthcare Provider Details

I. General information

NPI: 1073121364
Provider Name (Legal Business Name): SERENA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W 21ST ST APT 1
CLOVIS NM
88101-4087
US

IV. Provider business mailing address

27777 INKSTER RD STE 100
FARMINGTON HILLS MI
48334-5326
US

V. Phone/Fax

Practice location:
  • Phone: 575-288-1881
  • Fax:
Mailing address:
  • Phone: 248-299-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-72466
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: