Provider Demographics
NPI:1447604426
Name:GARCIA, DIEGO RODRIGUEZ
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:RODRIGUEZ
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 1:6083 N FIGARDEN DR # 124
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-3226
Mailing Address - Country:US
Mailing Address - Phone:559-706-0008
Mailing Address - Fax:
Practice Address - Street 1:1925 E DAKOTA AVE STE G
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4821
Practice Address - Country:US
Practice Address - Phone:559-600-4645
Practice Address - Fax:559-455-4633
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC10898101YM0800X
CALMFT118699106H00000X
CAAMFT100584106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health