Provider Demographics
NPI:1205648623
Name:GARCIA, TIMOTHY MATTHEW
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MATTHEW
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 1:4616 GLENDALE PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-1655
Mailing Address - Country:US
Mailing Address - Phone:505-615-3365
Mailing Address - Fax:
Practice Address - Street 1:4616 GLENDALE PL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-1655
Practice Address - Country:US
Practice Address - Phone:505-615-3365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician