Provider Demographics
NPI:1083276570
Name:GARCIA, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W LA VETA AVE UNIT P5
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4430
Mailing Address - Country:US
Mailing Address - Phone:949-662-7872
Mailing Address - Fax:
Practice Address - Street 1:1820 W ORANGEWOOD AVE STE 110
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-5056
Practice Address - Country:US
Practice Address - Phone:714-696-2862
Practice Address - Fax:714-242-9308
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247200000X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other