Healthcare Provider Details

I. General information

NPI: 1144187147
Provider Name (Legal Business Name): MISS KRISTINA MARIE GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7709 HEATHER DR
STOCKTON CA
95207-1407
US

IV. Provider business mailing address

7709 HEATHER DR
STOCKTON CA
95207-1407
US

V. Phone/Fax

Practice location:
  • Phone: 209-969-2392
  • Fax:
Mailing address:
  • Phone: 209-969-2392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number250219380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: