MEDICARE: MS. CHRISTINE LINDA GARCIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	1620	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OT 1620	OTHER	CA	CA. STATE LICENSE #

General Provider Information

NPI Number	:	1154613693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE LINDA GARCIA

Provider Business Mailing Address
First Line	:	1751 10TH ST
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-6205
Country	:	US
Telephone Number	:	310-372-4295
Fax Number	:

Provider Business Practice Location Address
First Line	:	1751 10TH ST
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-6205
Country	:	US
Telephone Number	:	310-372-4295
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2011
Last Update Date	:	05/03/2011

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