Healthcare Provider Details

I. General information

NPI: 1205599081
Provider Name (Legal Business Name): LEON ALPHONSO GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date: 07/02/2026
Reactivation Date: 07/23/2026

III. Provider practice location address

1430 E COOLEY DR STE 240
COLTON CA
92324-3936
US

IV. Provider business mailing address

1430 E COOLEY DR STE 240
COLTON CA
92324-3936
US

V. Phone/Fax

Practice location:
  • Phone: 909-514-1404
  • Fax:
Mailing address:
  • Phone: 909-514-1404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: