Healthcare Provider Details

I. General information

NPI: 1003597378
Provider Name (Legal Business Name): JUDITH GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 COHASSET RD STE 130
CHICO CA
95973-5403
US

IV. Provider business mailing address

3211 COHASSET RD STE 130
CHICO CA
95973-5403
US

V. Phone/Fax

Practice location:
  • Phone: 530-552-4627
  • Fax: 530-879-3823
Mailing address:
  • Phone: 530-552-4627
  • Fax: 530-879-3823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number36460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: