Provider Demographics
NPI:1093408742
Name:GARCIA, SARAH DOMINIQUE
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:DOMINIQUE
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 1:222 S HARBOR BLVD STE 650
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-3756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 S HARBOR BLVD STE 650
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3756
Practice Address - Country:US
Practice Address - Phone:714-871-5646
Practice Address - Fax:714-817-7368
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes172V00000XOther Service ProvidersCommunity Health Worker