Healthcare Provider Details

I. General information

NPI: 1598339723
Provider Name (Legal Business Name): SONIA MARIE GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11840 MAGNOLIA AVE STE C
RIVERSIDE CA
92503-4900
US

IV. Provider business mailing address

3261 MOUNTAINSIDE DR
CORONA CA
92882-8915
US

V. Phone/Fax

Practice location:
  • Phone: 951-465-3664
  • Fax:
Mailing address:
  • Phone: 951-347-4350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number116227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: