Healthcare Provider Details

I. General information

NPI: 1124746607
Provider Name (Legal Business Name): PAUL GARCIA LBSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 N SWAN ST
SILVER CITY NM
88061-5800
US

IV. Provider business mailing address

2810 N SWAN ST
SILVER CITY NM
88061-5800
US

V. Phone/Fax

Practice location:
  • Phone: 575-956-2000
  • Fax:
Mailing address:
  • Phone: 575-956-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSWB-2022-0437
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: