Provider Demographics
NPI:1063865905
Name:GARCIA, MARLENE (LPT)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPT
Mailing Address - Street 1:3466 SUN CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-3572
Mailing Address - Country:US
Mailing Address - Phone:760-245-8837
Mailing Address - Fax:760-245-8854
Practice Address - Street 1:12240 HESPERIA RD
Practice Address - Street 2:SUITE A
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8309
Practice Address - Country:US
Practice Address - Phone:760-245-8837
Practice Address - Fax:760-245-8854
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 34802167G00000X, 251S00000X, 374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No251S00000XAgenciesCommunity/Behavioral Health
No374700000XNursing Service Related ProvidersTechnician