Healthcare Provider Details

I. General information

NPI: 1235969064
Provider Name (Legal Business Name): ALEJANDRA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: N/A N/A ACSW

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 W 14TH ST
SAN PEDRO CA
90731-4396
US

IV. Provider business mailing address

2033 S CRESCENT AVE
SAN PEDRO CA
90731-5512
US

V. Phone/Fax

Practice location:
  • Phone: 310-519-8723
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW124165
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: