MEDICARE: NICOLAUS 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

General Provider Information

NPI Number	:	1902071004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLAUS GARCIA

Provider Business Mailing Address
First Line	:	PO BOX 26712
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-0712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 S LAKE AVE STE 284D
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-5074
Country	:	US
Telephone Number	:	805-622-0279
Fax Number	:

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

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	04/11/2018

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