Provider Demographics
NPI:1164892493
Name:GARCIA, ROBERT M
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 493188
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-3188
Mailing Address - Country:US
Mailing Address - Phone:530-710-8373
Mailing Address - Fax:530-248-3318
Practice Address - Street 1:5000 BECHELLI LN STE 103
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-3553
Practice Address - Country:US
Practice Address - Phone:530-710-8373
Practice Address - Fax:530-248-3313
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114163106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty