Provider Demographics
NPI:1326328915
Name:GARCIA, RANDOLPH JR
Entity Type:Individual
Prefix:MR
First Name:RANDOLPH
Middle Name:
Last Name:GARCIA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RANDY
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 730393
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95173-0393
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 PATTERSON ST UNIT 343
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5888
Practice Address - Country:US
Practice Address - Phone:408-655-4767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health