Basic Information
| Provider Information | |||||||||
| NPI: | 1013102797 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | MANUEL | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22741 IRONBARK DR | ||||||||
| Address2: | |||||||||
| City: | DIAMOND BAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917652519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262775327 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1539 W GARVEY AVE N | ||||||||
| Address2: | |||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917902139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269604844 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2007 | ||||||||
| LastUpdateDate: | 08/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | LCSW85999 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | ASW22982 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.