Provider Demographics
NPI:1508244807
Name:GARCIA, MARIA DE LOS ANGELES
Entity Type:Individual
Prefix:
First Name:MARIA DE LOS ANGELES
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARIA DE LOS ANGELES
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AOD
Mailing Address - Street 1:10423 CANADEO CIR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-3549
Mailing Address - Country:US
Mailing Address - Phone:916-394-2320
Mailing Address - Fax:
Practice Address - Street 1:10423 CANADEO CIR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-3549
Practice Address - Country:US
Practice Address - Phone:916-394-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR114721214Medicare PIN