Provider Demographics
NPI:1144317637
Name:GARCIA, RAFAEL M (PA-C)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:M
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 W OSBORN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3814
Mailing Address - Country:US
Mailing Address - Phone:602-230-1400
Mailing Address - Fax:602-230-7676
Practice Address - Street 1:444 W OSBORN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3814
Practice Address - Country:US
Practice Address - Phone:602-230-1400
Practice Address - Fax:602-230-7676
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2006-0034363A00000X
NMPA20060034363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM45050074Medicaid
NM100038Medicare PIN