Healthcare Provider Details

I. General information

NPI: 1164181913
Provider Name (Legal Business Name): ALVARO RAUL GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MAPLE AVE
LOS ANGELES CA
90013-1511
US

IV. Provider business mailing address

529 MAPLE AVE
LOS ANGELES CA
90013-1511
US

V. Phone/Fax

Practice location:
  • Phone: 213-629-6200
  • Fax:
Mailing address:
  • Phone: 213-629-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: