Basic Information
| Provider Information | |||||||||
| NPI: | 1447604426 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | DIEGO | ||||||||
| MiddleName: | RODRIGUEZ | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6083 N FIGARDEN DR # 124 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937223226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597060008 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1925 E DAKOTA AVE STE G | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937264821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596004645 | ||||||||
| FaxNumber: | 5594554633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2016 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LPCC10898 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | LMFT118699 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.