Healthcare Provider Details

I. General information

NPI: 1679764880
Provider Name (Legal Business Name): BALDOMERO P GARCIA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 HILLRISE DR SUITE A
LAS CRUCES NM
88011-4897
US

IV. Provider business mailing address

3003 HILLRISE DR SUITE A
LAS CRUCES NM
88011-4897
US

V. Phone/Fax

Practice location:
  • Phone: 505-521-7550
  • Fax: 505-521-7617
Mailing address:
  • Phone: 505-521-7550
  • Fax: 505-521-7617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number81-197
License Number StateNM

VIII. Authorized Official

Name: ROSIE LEON
Title or Position: MEDICAL ASST.
Credential:
Phone: 505-521-7550