Basic Information
| Provider Information | |||||||||
| NPI: | 1669744272 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | |||||||||
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| Credential: | BS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1039 | ||||||||
| Address2: | |||||||||
| City: | ROSEMEAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917701000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262806510 | ||||||||
| FaxNumber: | 6262881026 | ||||||||
| Practice Location | |||||||||
| Address1: | 3244 E GREEN ST | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911073836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268443033 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2012 | ||||||||
| LastUpdateDate: | 01/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 36303 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | 36303 | CA | N | Behavioral Health & Social Service Providers | Social Worker | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 104100000X | 93731 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 1457840373 | 01 | CA | MEDI-CAL | OTHER |