Basic Information
Provider Information
NPI: 1518361666
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARCIA
FirstName: FRANK
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 500575
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921500575
CountryCode: US
TelephoneNumber: 6193703233
FaxNumber:  
Practice Location
Address1: 524 W VISTA WAY
Address2:  
City: VISTA
State: CA
PostalCode: 920835704
CountryCode: US
TelephoneNumber: 7607581150
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/17/2014
LastUpdateDate: 04/28/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/28/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X62955CAN Behavioral Health & Social Service ProvidersCounselorMental Health
1041C0700X94664CAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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