Healthcare Provider Details

I. General information

NPI: 1285708933
Provider Name (Legal Business Name): ELIZABETH GARCIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 AVENIDA LAS CAMPANAS NW
LOS RANCHOS NM
87107-3204
US

IV. Provider business mailing address

1924 AVENIDA LAS CAMPANAS NW
LOS RANCHOS NM
87107-3204
US

V. Phone/Fax

Practice location:
  • Phone: 505-341-4730
  • Fax:
Mailing address:
  • Phone: 505-341-4730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number99-203
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: