Healthcare Provider Details

I. General information

NPI: 1174242531
Provider Name (Legal Business Name): ESMERALDA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 MCMILLAN AVE STE 136
SAN LUIS OBISPO CA
93401-6774
US

IV. Provider business mailing address

2945 MCMILLAN AVE STE 136
SAN LUIS OBISPO CA
93401-6774
US

V. Phone/Fax

Practice location:
  • Phone: 805-781-4881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT106788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: