Healthcare Provider Details

I. General information

NPI: 1215776893
Provider Name (Legal Business Name): GISSELLE GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2958 E FLORENCE AVE
HUNTINGTON PARK CA
90255-5826
US

IV. Provider business mailing address

900 CORPORATE CENTER DR STE 350
MONTEREY PARK CA
91754-7620
US

V. Phone/Fax

Practice location:
  • Phone: 323-923-9559
  • Fax: 323-926-9566
Mailing address:
  • Phone: 323-526-4016
  • Fax: 323-526-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: