=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114682028
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHANTELL NARAYA GARCIA ASSOCIATE IN ARTS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2021
-----------------------------------------------------
Last Update Date | 10/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1874 BUSINESS CENTER DR
-----------------------------------------------------
City | SAN BERNARDINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92408-3457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-386-0523
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1874 BUSINESS CENTER DR
-----------------------------------------------------
City | SAN BERNARDINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92408-3457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-386-0523
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | R1579050924
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------