Healthcare Provider Details

I. General information

NPI: 1194157495
Provider Name (Legal Business Name): PRISCILLA PITTMAN GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 B ST STE 1570
SAN DIEGO CA
92101-4560
US

IV. Provider business mailing address

730 MEDICAL CENTER CT
CHULA VISTA CA
91911-6618
US

V. Phone/Fax

Practice location:
  • Phone: 619-615-0439
  • Fax:
Mailing address:
  • Phone: 858-278-2847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number796313
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number796313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: