Provider Demographics
NPI:1114377496
Name:GARCIA, ZULLY
Entity Type:Individual
Prefix:
First Name:ZULLY
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 1:13536 LAKEWOOD BLVD # 105
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-2031
Mailing Address - Country:US
Mailing Address - Phone:626-539-1412
Mailing Address - Fax:
Practice Address - Street 1:10012 VALLEY BLVD APT 25
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1721
Practice Address - Country:US
Practice Address - Phone:626-539-1412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT95462106H00000X
106H00000X
CALMFT134154106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist