Healthcare Provider Details

I. General information

NPI: 1851222673
Provider Name (Legal Business Name): JEFFERSON JOSE GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S JEFFERSON ST
SPOKANE WA
99204-3121
US

IV. Provider business mailing address

813 S LINCOLN PL APT 2
SPOKANE WA
99204-5001
US

V. Phone/Fax

Practice location:
  • Phone: 509-903-5631
  • Fax:
Mailing address:
  • Phone: 509-750-1642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: