Healthcare Provider Details

I. General information

NPI: 1801803242
Provider Name (Legal Business Name): REYNA R GARCIA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 STONE LAKE RD.
DULCE NM
87528-0392
US

IV. Provider business mailing address

12000 STONE LAKE RD. PO BOX 187
DULCE NM
87528-0392
US

V. Phone/Fax

Practice location:
  • Phone: 505-759-3291
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR52967
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: