Healthcare Provider Details

I. General information

NPI: 1417364423
Provider Name (Legal Business Name): ADELITA GARCIA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3845 SPRING DR
SPRING VALLEY CA
91977-1030
US

IV. Provider business mailing address

4186 OREGON ST
SAN DIEGO CA
92104-1726
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2380
  • Fax:
Mailing address:
  • Phone: 210-885-5161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: