Provider Demographics
NPI:1588857700
Name:GARCIA, MARIA JACQUELINE
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:JACQUELINE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARIA
Other - Middle Name:JACQUELINE
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4000 MOORPARK AVE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1859
Mailing Address - Country:US
Mailing Address - Phone:408-316-8660
Mailing Address - Fax:408-501-7312
Practice Address - Street 1:4000 MOORPARK AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1859
Practice Address - Country:US
Practice Address - Phone:408-316-8660
Practice Address - Fax:408-501-7312
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist