Healthcare Provider Details

I. General information

NPI: 1144697277
Provider Name (Legal Business Name): CRISTIANNA GARCIA DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 S WALNUT ST BLDG 3
LAS CRUCES NM
88001-1425
US

IV. Provider business mailing address

780 S WALNUT ST BLDG 3
LAS CRUCES NM
88001-1425
US

V. Phone/Fax

Practice location:
  • Phone: 575-545-2697
  • Fax: 575-339-2030
Mailing address:
  • Phone: 575-545-2697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP128556
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCNP-02976
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: