Provider Demographics
NPI:1639782253
Name:GARCIA, JUSTIN (LAC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 S GLENDORA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6815
Mailing Address - Country:US
Mailing Address - Phone:626-629-3082
Mailing Address - Fax:
Practice Address - Street 1:931 BUENA VISTA ST STE 303
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1714
Practice Address - Country:US
Practice Address - Phone:626-629-3082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18825171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist