Provider Demographics
NPI:1497239172
Name:GARCIA, AMANDA DARLENE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DARLENE
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 1:107 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4820
Mailing Address - Country:US
Mailing Address - Phone:707-462-1934
Mailing Address - Fax:707-468-9860
Practice Address - Street 1:139 FORD ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4011
Practice Address - Country:US
Practice Address - Phone:707-462-1934
Practice Address - Fax:707-468-9860
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator