Healthcare Provider Details

I. General information

NPI: 1053843763
Provider Name (Legal Business Name): KIMBERLY GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 S ST LOUIS ST
LOS ANGELES CA
90033-4320
US

IV. Provider business mailing address

560 S ST LOUIS ST
LOS ANGELES CA
90033-4320
US

V. Phone/Fax

Practice location:
  • Phone: 213-480-1557
  • Fax:
Mailing address:
  • Phone: 213-480-1557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number130703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: