Basic Information
| Provider Information | |||||||||
| NPI: | 1568794550 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | JACQUELINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12756 VAN NUYS BLVD | ||||||||
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| City: | PACOIMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913311626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188960531 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12756 VAN NUYS BLVD | ||||||||
| Address2: | |||||||||
| City: | PACOIMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913311626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188960531 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2010 | ||||||||
| LastUpdateDate: | 04/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 93184 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.