Healthcare Provider Details

I. General information

NPI: 1699356147
Provider Name (Legal Business Name): LUIS S GARCIA ASW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17215 STUDEBAKER RD STE 110
CERRITOS CA
90703-2521
US

IV. Provider business mailing address

17215 STUDEBAKER RD STE 110
CERRITOS CA
90703-2521
US

V. Phone/Fax

Practice location:
  • Phone: 562-716-6726
  • Fax:
Mailing address:
  • Phone: 562-666-2576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number122959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: