Provider Demographics
NPI:1710581376
Name:GARCIA, JONATHAN VLADIMIR
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:VLADIMIR
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10533 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-7230
Mailing Address - Country:US
Mailing Address - Phone:213-326-5799
Mailing Address - Fax:
Practice Address - Street 1:8134 VAN NUYS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4818
Practice Address - Country:US
Practice Address - Phone:866-590-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)