Individual provider Active NPI

Quella Nicole Garcia, MS, CCC-CLP

  • Speech-Language Pathologist
  • Albuquerque, NM
National Provider Identifier
1194878884
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
3834 Issued in NM
Practice address
4505 Bali CT NE
Albuquerque, NM 87111-2801
Phone
(505) 264-3102
NPI assigned
Jan 18, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 3834 NM Primary

Addresses

Primary practice location

4505 Bali CT NE
Albuquerque, NM 87111-2801

Mailing address

6720 Butte Volcano Rd NW
Albuquerque, NM 87120-1431
Phone (505) 920-7979

Other identifiers 1

IdentifierTypeStateIssuer
68704551MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
3834NMMDSpeech-Language Pathologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194878884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6720 BUTTE VOLCANO RD NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871201431",
            "telephone_number": "505-920-7979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4505 BALI CT NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871112801",
            "telephone_number": "505-264-3102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARCIA",
        "first_name": "QUELLA",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "MS, CCC-CLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NM",
            "license": "3834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "68704551",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.