Healthcare Provider Details

I. General information

NPI: 1679020598
Provider Name (Legal Business Name): JANET GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 CLAYTON RD STE 200
CONCORD CA
94519-2700
US

IV. Provider business mailing address

616 SHADDICK DR
ANTIOCH CA
94509-5045
US

V. Phone/Fax

Practice location:
  • Phone: 925-798-9240
  • Fax:
Mailing address:
  • Phone: 925-234-3021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberE2998803
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberE2998803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: