Provider Demographics
NPI:1467772319
Name:GARCIA, MARIA D (LPT(PT35172))
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:D
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LPT(PT35172)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E. GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:SAN BNDO
Mailing Address - State:CA
Mailing Address - Zip Code:92415
Mailing Address - Country:US
Mailing Address - Phone:909-386-0785
Mailing Address - Fax:
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-580-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 35172167G00000X
CAPT35172167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician