Healthcare Provider Details

I. General information

NPI: 1073440699
Provider Name (Legal Business Name): MRS. KIMBERLY ELIZABETH GARCIA-BLANCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 E 6TH ST
TRACY CA
95376-4107
US

IV. Provider business mailing address

PO BOX 183
LATHROP CA
95330-0183
US

V. Phone/Fax

Practice location:
  • Phone: 209-835-8583
  • Fax:
Mailing address:
  • Phone: 650-440-9773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: