Provider Demographics
NPI:1235994765
Name:GARCIA, VICTORIA I
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:I
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 1:5425 POMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1716
Mailing Address - Country:US
Mailing Address - Phone:323-728-0411
Mailing Address - Fax:
Practice Address - Street 1:11541 ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3898
Practice Address - Country:US
Practice Address - Phone:562-923-9414
Practice Address - Fax:562-923-9451
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA654472171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator