Basic Information
| Provider Information | |||||||||
| NPI: | 1790152692 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | LETICIA | ||||||||
| MiddleName: | TERESA | ||||||||
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| OtherLastName: | GARCIA | ||||||||
| OtherFirstName: | LETY | ||||||||
| OtherMiddleName: | TERESA | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 507 PEPPER TREE DR | ||||||||
| Address2: | |||||||||
| City: | BREA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928213315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144828814 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 680 LANGSDORF DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928313702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148719264 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2015 | ||||||||
| LastUpdateDate: | 05/10/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.