Healthcare Provider Details

I. General information

NPI: 1144184664
Provider Name (Legal Business Name): MERCELL A GARCIA CHW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 EAGLE CT
SANTO DOMINGO PUEBLO NM
87052-1230
US

IV. Provider business mailing address

147 ZUNI ST
SANTO DOMINGO PUEBLO NM
87052-1281
US

V. Phone/Fax

Practice location:
  • Phone: 505-465-2733
  • Fax: 505-465-0433
Mailing address:
  • Phone: 505-465-2733
  • Fax: 505-465-0433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberG-1892
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: