MEDICARE: MR. JOSE LUIS 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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1932261872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSE LUIS GARCIA

Provider Business Mailing Address
First Line	:	1585 S D ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3257
Country	:	US
Telephone Number	:	909-388-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1585 S D ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3257
Country	:	US
Telephone Number	:	909-388-2222
Fax Number	:

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	03/12/2018

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