Healthcare Provider Details

I. General information

NPI: 1386171965
Provider Name (Legal Business Name): NORMA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 09/16/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N THORNTON ST STE H
CLOVIS NM
88101-5508
US

IV. Provider business mailing address

1200 N THORNTON ST STE H
CLOVIS NM
88101-5508
US

V. Phone/Fax

Practice location:
  • Phone: 575-935-4411
  • Fax:
Mailing address:
  • Phone: 575-935-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX-11972
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: