Healthcare Provider Details

I. General information

NPI: 1710995832
Provider Name (Legal Business Name): TIM GARCIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6349 HIGHWAY 550
CUBA NM
87013
US

IV. Provider business mailing address

7406 CORRALES RD
CORRALES NM
87048-9020
US

V. Phone/Fax

Practice location:
  • Phone: 505-289-3291
  • Fax: 505-289-9101
Mailing address:
  • Phone: 505-792-0170
  • Fax: 505-289-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number93264
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: