Healthcare Provider Details

I. General information

NPI: 1871994533
Provider Name (Legal Business Name): JENNIFER GARCIA ASW 63502
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 E. CESAR CHAVEZ AVE.
LOS ANGELES CA
90022
US

IV. Provider business mailing address

4701 E CESAR E CHAVEZ AVE
EAST LOS ANGELES CA
90022-1209
US

V. Phone/Fax

Practice location:
  • Phone: 323-881-3799
  • Fax: 323-260-5202
Mailing address:
  • Phone: 323-881-3799
  • Fax: 323-260-5202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number63502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: