Provider Demographics
NPI:1740949049
Name:GARCIA, CLARISSA (NP)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:NM
Mailing Address - Zip Code:87732-0209
Mailing Address - Country:US
Mailing Address - Phone:575-387-5069
Mailing Address - Fax:
Practice Address - Street 1:3 MORA VALLEY CLINIC RD
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:NM
Practice Address - Zip Code:87732-2202
Practice Address - Country:US
Practice Address - Phone:575-387-5069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM65836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily