Healthcare Provider Details

I. General information

NPI: 1467772319
Provider Name (Legal Business Name): MARIA D GARCIA LPT(PT35172)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PEPPER AVE
COLTON CA
92324-1801
US

IV. Provider business mailing address

900 E. GILBERT ST
SAN BNDO CA
92415
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-1800
  • Fax:
Mailing address:
  • Phone: 909-386-0785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT 35172
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT35172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: