Healthcare Provider Details

I. General information

NPI: 1215614433
Provider Name (Legal Business Name): JOHN GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 HOWARD WAY STE 150
COSTA MESA CA
92626-1496
US

IV. Provider business mailing address

2001 E 4TH ST STE 200
SANTA ANA CA
92705-3916
US

V. Phone/Fax

Practice location:
  • Phone: 949-646-9227
  • Fax:
Mailing address:
  • Phone: 714-824-8140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: