Healthcare Provider Details

I. General information

NPI: 1982767331
Provider Name (Legal Business Name): HENRY A GARCIA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 GRANDE BLVD SE STE A
RIO RANCHO NM
87124-1687
US

IV. Provider business mailing address

2220 GRANDE BLVD SE STE A
RIO RANCHO NM
87124-1687
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-9800
  • Fax: 505-994-4524
Mailing address:
  • Phone: 505-892-9800
  • Fax: 505-994-4524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number81-198
License Number StateNM

VIII. Authorized Official

Name: DR. HENRY A. GARCIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 505-892-9800