Healthcare Provider Details

I. General information

NPI: 1053802249
Provider Name (Legal Business Name): CAROLINA GARCIA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21545 CENTRE POINTE PKWY
SANTA CLARITA CA
91350-2947
US

IV. Provider business mailing address

11017 LUDDINGTON ST
SUN VALLEY CA
91352-2718
US

V. Phone/Fax

Practice location:
  • Phone: 661-259-9439
  • Fax: 661-362-1030
Mailing address:
  • Phone: 818-308-0639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW128320
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: