MEDICARE: RICHARD ROBERT GARCIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	28742	CA

General Provider Information

NPI Number	:	1881198554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD ROBERT GARCIA

Provider Business Mailing Address
First Line	:	2471 MYRTLE BEACH WAY
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-2150
Country	:	US
Telephone Number	:	619-254-1710
Fax Number	:

Provider Business Practice Location Address
First Line	:	2471 MYRTLE BEACH WAY
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-2150
Country	:	US
Telephone Number	:	619-254-1710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2018
Last Update Date	:	03/19/2018

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