Provider Demographics
NPI:1639782253
Name:GARCIA, JUSTIN (LAC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:GARCIA
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 DTC PKWY STE 1130
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3038
Mailing Address - Country:US
Mailing Address - Phone:720-749-5599
Mailing Address - Fax:
Practice Address - Street 1:6622 N 91ST AVE STE 230
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-2570
Practice Address - Country:US
Practice Address - Phone:602-325-2024
Practice Address - Fax:720-925-5897
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18825171100000X
AZLAC-012235171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist