Healthcare Provider Details

I. General information

NPI: 1366094336
Provider Name (Legal Business Name): MS. JESSENIA NOHELI GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 DAVIDSON AVE
SAN BERNARDINO CA
92405-1917
US

IV. Provider business mailing address

2833 DAVIDSON AVE
SAN BERNARDINO CA
92405-1917
US

V. Phone/Fax

Practice location:
  • Phone: 323-718-1260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number95324
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number123817
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: