Healthcare Provider Details

I. General information

NPI: 1841152980
Provider Name (Legal Business Name): VANESSA R GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 SUNRISE AVE
MODESTO CA
95350-4643
US

IV. Provider business mailing address

1440 SUNRISE AVE
MODESTO CA
95350-4643
US

V. Phone/Fax

Practice location:
  • Phone: 209-492-4628
  • Fax:
Mailing address:
  • Phone: 209-492-4628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: