MEDICARE: GRAZEL GARCIA LMFT

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	390200000X	Student in an Organized Health Care Education/Training Program
2	106H00000X	Marriage & Family Therapist	97561	CA

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	:	1689928442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRAZEL GARCIA LMFT

Provider Business Mailing Address
First Line	:	3401 GLENDALE BLVD UNIT B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1814
Country	:	US
Telephone Number	:	323-487-9003
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 GLENDALE BLVD UNIT B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1814
Country	:	US
Telephone Number	:	323-487-9003
Fax Number	:

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

Provider Enumeration Date	:	11/01/2012
Last Update Date	:	03/17/2018

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