Provider Demographics
NPI:1689919276
Name:GARCIA-GONZALEZ, MYRA (PSYD, MPA)
Entity Type:Individual
Prefix:DR
First Name:MYRA
Middle Name:
Last Name:GARCIA-GONZALEZ
Suffix:
Gender:F
Credentials:PSYD, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8939 S SEPULVEDA BLVD
Mailing Address - Street 2:STE. 110 #259
Mailing Address - City:WESTCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1351
Mailing Address - Country:US
Mailing Address - Phone:787-463-7240
Mailing Address - Fax:
Practice Address - Street 1:20101 HAMILTON AVE STE 155A
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1351
Practice Address - Country:US
Practice Address - Phone:213-328-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-07
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28270103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical