=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679764880
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BALDOMERO P GARCIA MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2007
-----------------------------------------------------
Last Update Date | 09/11/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3003 HILLRISE DR SUITE A
-----------------------------------------------------
City | LAS CRUCES
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88011-4897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-521-7550
-----------------------------------------------------
Fax | 505-521-7617
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3003 HILLRISE DR SUITE A
-----------------------------------------------------
City | LAS CRUCES
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88011-4897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-521-7550
-----------------------------------------------------
Fax | 505-521-7617
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL ASST.
-----------------------------------------------------
Name | ROSIE LEON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 505-521-7550
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 81-197
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------