Provider Demographics
NPI:1295469641
Name:ACACIA FAMILY PRACTICE GROUP OF LAKE HAVASU, INC
Entity Type:Organization
Organization Name:ACACIA FAMILY PRACTICE GROUP OF LAKE HAVASU, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SILVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:928-246-4025
Mailing Address - Street 1:1951 MESQUITE AVE STE H
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5746
Mailing Address - Country:US
Mailing Address - Phone:928-550-7036
Mailing Address - Fax:
Practice Address - Street 1:1951 MESQUITE AVE STE H
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5746
Practice Address - Country:US
Practice Address - Phone:928-550-7036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty