Healthcare Provider Details

I. General information

NPI: 1528614088
Provider Name (Legal Business Name): JESSICA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 1ST ST
TUSTIN CA
92780-3312
US

IV. Provider business mailing address

3744 E CHAPMAN AVE UNIT 12243
ORANGE CA
92859-8550
US

V. Phone/Fax

Practice location:
  • Phone: 714-730-1428
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number136157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: