Healthcare Provider Details

I. General information

NPI: 1578745352
Provider Name (Legal Business Name): KRISTEN GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTEN RODRIGUEZ

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 E SHAW AVE STE 150
FRESNO CA
93710-8109
US

IV. Provider business mailing address

1630 E SHAW AVE STE 150
FRESNO CA
93710-8109
US

V. Phone/Fax

Practice location:
  • Phone: 559-248-8550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number96307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: