MEDICARE: MS. SANDRA VIVIANA GARZON

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	106H00000X	Marriage & Family Therapist	MT3989	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376825372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA VIVIANA GARZON

Provider Business Mailing Address
First Line	:	12957 RAMONA AVE APT 94
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-5968
Country	:	US
Telephone Number	:	626-221-1478
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 SOUTH MYRLE AVE.
Second Line	:
City	:	MONROVIA
State	:	CA
Zip	:	91016-5968
Country	:	US
Telephone Number	:	626-357-3258
Fax Number	:

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

Provider Enumeration Date	:	09/15/2011
Last Update Date	:	07/28/2021

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