Healthcare Provider Details

I. General information

NPI: 1346189818
Provider Name (Legal Business Name): JORGE LUIS GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E MARKET ST
LONG BEACH CA
90805-5924
US

IV. Provider business mailing address

2302 GRANT AVE
REDONDO BEACH CA
90278-4588
US

V. Phone/Fax

Practice location:
  • Phone: 562-428-4222
  • Fax:
Mailing address:
  • Phone: 323-535-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: