Healthcare Provider Details

I. General information

NPI: 1851569370
Provider Name (Legal Business Name): EDDIE ABLE GARCIA II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 S. LINDEN
MESILLA PARK NM
88005
US

IV. Provider business mailing address

PO BOX 1000
MESILLA PARK NM
88047-1000
US

V. Phone/Fax

Practice location:
  • Phone: 505-650-4367
  • Fax:
Mailing address:
  • Phone: 505-650-4367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number03128269005
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: