Provider Demographics
NPI:1487000212
Name:GARCIA, JORGE
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 ANTHONY DR
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-9346
Mailing Address - Country:US
Mailing Address - Phone:575-201-5135
Mailing Address - Fax:575-201-5108
Practice Address - Street 1:385 CALLE DE ALEGRA
Practice Address - Street 2:BLDG. A
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3423
Practice Address - Country:US
Practice Address - Phone:575-526-1105
Practice Address - Fax:575-524-4266
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator