Provider Demographics
NPI:1699021154
Name:GARCIA, STEFANIE A
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:A
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 GOODRICH BOULVARD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90022
Mailing Address - Country:US
Mailing Address - Phone:323-725-1337
Mailing Address - Fax:323-725-1337
Practice Address - Street 1:1436 GOODRICH BLVD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90022-5111
Practice Address - Country:US
Practice Address - Phone:323-725-1337
Practice Address - Fax:323-278-5344
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115078106H00000X
CA73910106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist