Provider Demographics
NPI:1629362058
Name:GARCIA, RAYMOND JOE
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JOE
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 1:13525 WITCHER AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-6344
Mailing Address - Country:US
Mailing Address - Phone:505-750-2041
Mailing Address - Fax:505-332-2496
Practice Address - Street 1:13525 WITCHER AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-6344
Practice Address - Country:US
Practice Address - Phone:505-750-2041
Practice Address - Fax:505-332-2496
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSSWB-2023-0292104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker