Provider Demographics
NPI:1619536778
Name:GARCIA, IVETTE (MSW)
Entity Type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10630 EMPIRE DR
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-2039
Mailing Address - Country:US
Mailing Address - Phone:323-718-0496
Mailing Address - Fax:
Practice Address - Street 1:40005 10TH ST W STE 106
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3037
Practice Address - Country:US
Practice Address - Phone:661-265-8627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA905651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker