Healthcare Provider Details

I. General information

NPI: 1982101911
Provider Name (Legal Business Name): ERIN KATHLEEN GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E CHANNEL ST
STOCKTON CA
95202-2628
US

IV. Provider business mailing address

7210 MURRAY DR
STOCKTON CA
95210-3339
US

V. Phone/Fax

Practice location:
  • Phone: 209-373-2821
  • Fax:
Mailing address:
  • Phone: 209-373-2821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-11239
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1023472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: