Healthcare Provider Details

I. General information

NPI: 1609043728
Provider Name (Legal Business Name): ALICIA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3686 PACIFIC AVE
RIVERSIDE CA
92509-1948
US

IV. Provider business mailing address

3686 PACIFIC AVE
RIVERSIDE CA
92509-1948
US

V. Phone/Fax

Practice location:
  • Phone: 951-663-4842
  • Fax:
Mailing address:
  • Phone: 951-663-4842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: