Healthcare Provider Details

I. General information

NPI: 1093690935
Provider Name (Legal Business Name): LAUREN SUSANNE GARCIA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6086 COMEY AVE
LOS ANGELES CA
90034-2204
US

IV. Provider business mailing address

2012 CASA GRANDE CT
MODESTO CA
95355-5101
US

V. Phone/Fax

Practice location:
  • Phone: 310-915-6100
  • Fax:
Mailing address:
  • Phone: 209-484-9130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT41850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: