Provider Demographics
NPI:1144571688
Name:GARCIA MARAVILLAS, CHRISTIAN BERNARDO (LMFT)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:BERNARDO
Last Name:GARCIA MARAVILLAS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15843 FIRETHORN RD
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-1062
Mailing Address - Country:US
Mailing Address - Phone:323-318-4639
Mailing Address - Fax:
Practice Address - Street 1:5225 CANYON CREST DR BLDG 100
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-6301
Practice Address - Country:US
Practice Address - Phone:951-248-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101770106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist