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General NPI Number Information
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NPI Number | 1215253638
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Entity Type | Individual
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Provider Name | GRACE C GARCIA-WIGGEN RN, MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/09/2010
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Last Update Date | 04/09/2010
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Provider Practice Location Address
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Address Line | 6060 SUNRISE VISTA DR SUITE 2000E
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95610-7053
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Country | US
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Telephone | 916-969-8975
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Fax | 916-209-9653
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Provider Business Mailing Address
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Address Line | 6060 SUNRISE VISTA DR SUITE 2000E
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95610-7053
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Country | US
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Telephone | 916-969-8975
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Fax | 916-209-9653
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS25951
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License Number State | CA
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