Healthcare Provider Details

I. General information

NPI: 1245002187
Provider Name (Legal Business Name): JADE GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1574 NM 502
SANTA FE NM
87506-2697
US

IV. Provider business mailing address

1321 ST HWY 75
PENASCO NM
87553
US

V. Phone/Fax

Practice location:
  • Phone: 505-455-2234
  • Fax:
Mailing address:
  • Phone: 575-779-4801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: