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General NPI Number Information
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NPI Number | 1093530453
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Entity Type | Individual
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Provider Name | RUDOLPH GARCIA
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Gender | Male
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 2441 S NADINE ST
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City | WEST COVINA
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State | CA
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Zip | 91792-3562
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Country | US
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Telephone | 562-714-2069
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Fax |
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Provider Business Mailing Address
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Address Line | 831 E ARROW HWY
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City | POMONA
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State | CA
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Zip | 91767-2535
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Country | US
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Telephone | 909-398-4383
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | R1554040324
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License Number State | CA
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