Provider Demographics
NPI:1861627416
Name:GARCIA, IRENE (MS)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 INLAND EMPIRE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4899
Mailing Address - Country:US
Mailing Address - Phone:909-980-3427
Mailing Address - Fax:909-945-3426
Practice Address - Street 1:2990 INLAND EMPIRE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4899
Practice Address - Country:US
Practice Address - Phone:909-980-3427
Practice Address - Fax:909-945-3426
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF59770101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health