Healthcare Provider Details

I. General information

NPI: 1073322335
Provider Name (Legal Business Name): JESSICA MARIA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 WALNUT TRL
FRAZIER PARK CA
93225
US

IV. Provider business mailing address

PO BOX 64
FRAZIER PARK CA
93225-0064
US

V. Phone/Fax

Practice location:
  • Phone: 661-703-7433
  • Fax:
Mailing address:
  • Phone: 661-703-7433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number21086
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: