Provider Demographics
NPI:1124700562
Name:GARCIA, VICTORIA MAE (CDP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MAE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 73 BOX 549
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:NM
Mailing Address - Zip Code:87565-9714
Mailing Address - Country:US
Mailing Address - Phone:505-469-7773
Mailing Address - Fax:505-657-7733
Practice Address - Street 1:43 BIG CHEIF RD
Practice Address - Street 2:
Practice Address - City:ILFELD
Practice Address - State:NM
Practice Address - Zip Code:87538
Practice Address - Country:US
Practice Address - Phone:505-469-7773
Practice Address - Fax:505-657-7733
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM68882832278H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome HealthGroup - Single Specialty