Healthcare Provider Details

I. General information

NPI: 1508596644
Provider Name (Legal Business Name): YULIANA LIZETH GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E HACKETT RD
MODESTO CA
95358-9001
US

IV. Provider business mailing address

1231 8TH ST STE 300
MODESTO CA
95354-2235
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-7218
  • Fax:
Mailing address:
  • Phone: 209-525-7339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: