Provider Demographics
NPI:1497881999
Name:GARCIA, BLANCA NELLY
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:NELLY
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 1:720 S FRONTAGE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-5626
Mailing Address - Country:US
Mailing Address - Phone:805-242-6522
Mailing Address - Fax:805-540-5890
Practice Address - Street 1:720 S FRONTAGE RD STE 103
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-5626
Practice Address - Country:US
Practice Address - Phone:805-598-7175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist