MEDICARE: DIANA 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	103K00000X	Behavior Analyst	1-15-19272	CA

General Provider Information

NPI Number	:	1740656768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA GARCIA

Provider Business Mailing Address
First Line	:	2088 E LAKESHORE DR APT 912
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-4492
Country	:	US
Telephone Number	:	951-691-3688
Fax Number	:

Provider Business Practice Location Address
First Line	:	2088 E LAKESHORE DR APT 912
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-4492
Country	:	US
Telephone Number	:	951-691-3688
Fax Number	:

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

Provider Enumeration Date	:	08/13/2015
Last Update Date	:	08/13/2015

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