Healthcare Provider Details

I. General information

NPI: 1689705279
Provider Name (Legal Business Name): MS. REVA GARCIA GONZALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E FESLER ST
SANTA MARIA CA
93454-4404
US

IV. Provider business mailing address

2678 GREENWOOD AVE
MORRO BAY CA
93442-1547
US

V. Phone/Fax

Practice location:
  • Phone: 805-922-6597
  • Fax: 805-922-5978
Mailing address:
  • Phone: 805-772-8630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: