Basic Information
| Provider Information | |||||||||
| NPI: | 1124169917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | KATIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | B.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9723 STATE ST APT B | ||||||||
| Address2: | |||||||||
| City: | SOUTH GATE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902804310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136390251 | ||||||||
| FaxNumber: | 2133882816 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 WILSHIRE BL STE 500 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136390251 | ||||||||
| FaxNumber: | 2133882816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 08/19/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.