Healthcare Provider Details

I. General information

NPI: 1811804586
Provider Name (Legal Business Name): VANESSA ITZEL GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 W BALL RD STE 4A
ANAHEIM CA
92804-5589
US

IV. Provider business mailing address

711 POLK ST
SANTA MARIA CA
93458-1331
US

V. Phone/Fax

Practice location:
  • Phone: 805-720-8028
  • Fax:
Mailing address:
  • Phone: 805-720-8028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberY7460479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: