Healthcare Provider Details

I. General information

NPI: 1336051135
Provider Name (Legal Business Name): DENISSE MARLYN GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 CANYON CREST DR
RIVERSIDE CA
92507-7921
US

IV. Provider business mailing address

706 W 91ST ST
LOS ANGELES CA
90044-6434
US

V. Phone/Fax

Practice location:
  • Phone: 323-910-7452
  • Fax:
Mailing address:
  • Phone: 323-901-1517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberY6498700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: