Healthcare Provider Details

I. General information

NPI: 1992644280
Provider Name (Legal Business Name): VIVIANA VANESSA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 W SANTA ROSALIA DR
IMPERIAL CA
92251-8854
US

IV. Provider business mailing address

272 W SANTA ROSALIA DR
IMPERIAL CA
92251-8854
US

V. Phone/Fax

Practice location:
  • Phone: 760-960-6154
  • Fax:
Mailing address:
  • Phone: 760-960-6154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT162086
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: