Healthcare Provider Details

I. General information

NPI: 1952088908
Provider Name (Legal Business Name): AUTUMN GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 PEDLEY RD
JURUPA VALLEY CA
92509-3966
US

IV. Provider business mailing address

4850 PEDLEY RD
JURUPA VALLEY CA
92509-3966
US

V. Phone/Fax

Practice location:
  • Phone: 951-360-4100
  • Fax:
Mailing address:
  • Phone: 951-360-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number0823F39A89
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: