Healthcare Provider Details

I. General information

NPI: 1043146715
Provider Name (Legal Business Name): KEATON GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SOUTHGATE RD
SACRAMENTO CA
95815-3823
US

IV. Provider business mailing address

1173 56TH AVE
SACRAMENTO CA
95831-3145
US

V. Phone/Fax

Practice location:
  • Phone: 916-566-2755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: