Provider Demographics
NPI:1144184664
Name:GARCIA, MERCELL A (CHW)
Entity type:Individual
Prefix:
First Name:MERCELL
Middle Name:A
Last Name:GARCIA
Suffix:
Gender:M
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 ZUNI ST
Mailing Address - Street 2:
Mailing Address - City:SANTO DOMINGO PUEBLO
Mailing Address - State:NM
Mailing Address - Zip Code:87052-1281
Mailing Address - Country:US
Mailing Address - Phone:505-465-2733
Mailing Address - Fax:505-465-0433
Practice Address - Street 1:18 EAGLE CT
Practice Address - Street 2:
Practice Address - City:SANTO DOMINGO PUEBLO
Practice Address - State:NM
Practice Address - Zip Code:87052-1230
Practice Address - Country:US
Practice Address - Phone:505-465-2733
Practice Address - Fax:505-465-0433
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-10
Last Update Date:2025-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMG-1892172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker