Provider Demographics
NPI:1396990933
Name:GARCIA, MICHAEL JAY (LPN)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAY
Last Name:GARCIA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 FAIRBANKS DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-5397
Mailing Address - Country:US
Mailing Address - Phone:505-771-0110
Mailing Address - Fax:
Practice Address - Street 1:7108 FAIRBANKS DR N.E.
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-0000
Practice Address - Country:US
Practice Address - Phone:505-771-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NML19946164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse