Healthcare Provider Details

I. General information

NPI: 1972627545
Provider Name (Legal Business Name): VICTORIA RUBI GARDEA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11731 TELEGRAPH RD STE K
SANTA FE SPRINGS CA
90670-6815
US

IV. Provider business mailing address

1052 EAGLEMONT AVENUE
WHITTIER CA
90601-1219
US

V. Phone/Fax

Practice location:
  • Phone: 626-348-4611
  • Fax:
Mailing address:
  • Phone: 626-252-5608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW103112
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW103112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: