Healthcare Provider Details

I. General information

NPI: 1063986586
Provider Name (Legal Business Name): NICHOLAS RUBEN GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 GROVE ST
SAN FRANCISCO CA
94117-1008
US

IV. Provider business mailing address

2157 GROVE ST
SAN FRANCISCO CA
94117-1008
US

V. Phone/Fax

Practice location:
  • Phone: 415-387-2275
  • Fax: 415-387-2677
Mailing address:
  • Phone: 415-387-2275
  • Fax: 415-387-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: