Healthcare Provider Details

I. General information

NPI: 1013715440
Provider Name (Legal Business Name): ILSA GLORIA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 185TH ST
TORRANCE CA
90504-4799
US

IV. Provider business mailing address

410 CAMINO REAL
REDONDO BEACH CA
90277-3815
US

V. Phone/Fax

Practice location:
  • Phone: 310-533-4527
  • Fax:
Mailing address:
  • Phone: 310-316-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC23199
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: