Healthcare Provider Details

I. General information

NPI: 1699204230
Provider Name (Legal Business Name): OLIVIA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 S AVENUE C
PORTALES NM
88130-6253
US

IV. Provider business mailing address

321 S AVENUE C
PORTALES NM
88130-6253
US

V. Phone/Fax

Practice location:
  • Phone: 575-760-0754
  • Fax:
Mailing address:
  • Phone: 575-760-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: