MEDICARE: MRS. GRACE C GARCIA-WIGGEN RN, MSW, LCSW

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	1041C0700X	Clinical Social Worker	LCS25951	CA

General Provider Information

NPI Number	:	1215253638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRACE C GARCIA-WIGGEN RN, MSW, LCSW

Provider Business Mailing Address
First Line	:	6060 SUNRISE VISTA DR
Second Line	:	SUITE 2000E
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-7053
Country	:	US
Telephone Number	:	916-969-8975
Fax Number	:	916-209-9653

Provider Business Practice Location Address
First Line	:	6060 SUNRISE VISTA DR
Second Line	:	SUITE 2000E
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-7053
Country	:	US
Telephone Number	:	916-969-8975
Fax Number	:	916-209-9653

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

Provider Enumeration Date	:	04/09/2010
Last Update Date	:	04/09/2010

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