Basic Information
| Provider Information | |||||||||
| NPI: | 1316604309 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GARCIA | ||||||||
| FirstName: | ZACHARIAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6600 8TH ST UNIT 7103 | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806341399 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 23RD AVE | ||||||||
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| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806346070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027474000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2021 | ||||||||
| LastUpdateDate: | 11/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 1083642680 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | W166044 | 05 | CO | MEDICAID |