Provider Demographics
NPI:1437741683
Name:GARCIA RODRIGUEZ, DIEGO (PHD)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:
Last Name:GARCIA RODRIGUEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:DIEGO
Other - Middle Name:A
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:3807 W 116TH ST
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2625
Mailing Address - Country:US
Mailing Address - Phone:310-817-1276
Mailing Address - Fax:
Practice Address - Street 1:3807 W 116TH ST
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2625
Practice Address - Country:US
Practice Address - Phone:310-817-1276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist