Healthcare Provider Details

I. General information

NPI: 1720128754
Provider Name (Legal Business Name): ANGELICA SILVIA COMBS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELICA SILVIA GARCIA LCSW

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E FOOTHILL BLVD
RIALTO CA
92376-5230
US

IV. Provider business mailing address

850 E FOOTHILL BLVD
RIALTO CA
92376-5230
US

V. Phone/Fax

Practice location:
  • Phone: 909-421-9495
  • Fax: 909-421-9494
Mailing address:
  • Phone: 909-421-9380
  • Fax: 909-421-9494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: