Healthcare Provider Details

I. General information

NPI: 1245265438
Provider Name (Legal Business Name): HENRY A GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/25/2011
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 Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81198
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: