Basic Information
| Provider Information | |||||||||
| NPI: | 1700023660 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CADAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 470 E 3RD ST STE C | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900131630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136205712 | ||||||||
| FaxNumber: | 2136214155 | ||||||||
| Practice Location | |||||||||
| Address1: | 470 E 3RD ST STE C | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900131630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136205712 | ||||||||
| FaxNumber: | 2136214155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2009 | ||||||||
| LastUpdateDate: | 11/10/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YA0400X | AII7581214 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.