Provider Demographics
NPI:1679764880
Name:BALDOMERO P GARCIA MD PA
Entity type:Organization
Organization Name:BALDOMERO P GARCIA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASST.
Authorized Official - Prefix:
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-521-7550
Mailing Address - Street 1:3003 HILLRISE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4897
Mailing Address - Country:US
Mailing Address - Phone:505-521-7550
Mailing Address - Fax:505-521-7617
Practice Address - Street 1:3003 HILLRISE DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4897
Practice Address - Country:US
Practice Address - Phone:505-521-7550
Practice Address - Fax:505-521-7617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM81-197261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2134697OtherMEDICARE ID
NM21170Medicaid
NM011001OtherBCBS
NM21170Medicaid