Provider Demographics
NPI:1154868420
Name:GARCIA, EVERARDO (MSN, APRN, PMHNP)
Entity Type:Individual
Prefix:MR
First Name:EVERARDO
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MSN, APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 LANG AVE NE STE 110
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4475
Mailing Address - Country:US
Mailing Address - Phone:505-551-1994
Mailing Address - Fax:
Practice Address - Street 1:4801 LANG AVE NE STE 110
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4475
Practice Address - Country:US
Practice Address - Phone:505-393-7493
Practice Address - Fax:330-578-7877
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022888163W00000X
CA95008494363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse