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General NPI Number Information
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NPI Number | 1295090264
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Entity Type | Organization
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Legal Business Name | MONTE VISTA MEDICAL LLC
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 1518 GIRARD BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-1823
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Country | US
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Telephone | 505-268-1480
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Fax | 505-268-1799
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Provider Business Mailing Address
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Address Line | 1518 GIRARD BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-1823
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Country | US
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Telephone | 505-268-1480
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Fax | 505-268-1799
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELISSA M GARCIA
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Credential | M.D.
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Telephone | 505-249-7913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 98-268
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License Number State | NM
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