Provider Demographics
NPI:1518402718
Name:GARCIA, RENA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RENA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3428 CUESTA DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-1706
Mailing Address - Country:US
Mailing Address - Phone:408-509-9498
Mailing Address - Fax:
Practice Address - Street 1:20400 SARATOGA LOS GATOS RD
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-5927
Practice Address - Country:US
Practice Address - Phone:408-509-9498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-23
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24025235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist