Provider Demographics
NPI:1588179022
Name:GARCIA, MILA (RN)
Entity Type:Individual
Prefix:
First Name:MILA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 S GLOBE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-6937
Mailing Address - Country:US
Mailing Address - Phone:575-356-7090
Mailing Address - Fax:575-356-2846
Practice Address - Street 1:1415 S GLOBE AVE
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6937
Practice Address - Country:US
Practice Address - Phone:575-356-7090
Practice Address - Fax:575-356-2846
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR52674163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool