Provider Demographics
NPI:1619750221
Name:GARCIA RODRIGUEZ, ALISA (MCW II)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:
Last Name:GARCIA RODRIGUEZ
Suffix:
Gender:F
Credentials:MCW II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36635 PEARL PL
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-7994
Mailing Address - Country:US
Mailing Address - Phone:661-618-7153
Mailing Address - Fax:
Practice Address - Street 1:919 1ST ST
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-2957
Practice Address - Country:US
Practice Address - Phone:818-256-2206
Practice Address - Fax:818-361-3210
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator