Healthcare Provider Details

I. General information

NPI: 1568018935
Provider Name (Legal Business Name): ZEBASTIAN GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E 19TH ST
ROSWELL NM
88201-5151
US

IV. Provider business mailing address

1 MANZANITA DR
BELEN NM
87002-9518
US

V. Phone/Fax

Practice location:
  • Phone: 575-625-3372
  • Fax:
Mailing address:
  • Phone: 505-410-4482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA1610
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: