Healthcare Provider Details

I. General information

NPI: 1629647813
Provider Name (Legal Business Name): SYLVIA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W CLINTON AVE R,S,Y,D,P
FRESNO CA
93705-4206
US

IV. Provider business mailing address

2550 W CLINTON AVE R,S,Y,D,P
FRESNO CA
93705-4206
US

V. Phone/Fax

Practice location:
  • Phone: 559-264-7521
  • Fax:
Mailing address:
  • Phone: 559-264-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11601
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: