Provider Demographics
NPI:1881198554
Name:GARCIA, RICHARD ROBERT
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ROBERT
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 1:2471 MYRTLE BEACH WAY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-2150
Mailing Address - Country:US
Mailing Address - Phone:619-254-1710
Mailing Address - Fax:
Practice Address - Street 1:2471 MYRTLE BEACH WAY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-2150
Practice Address - Country:US
Practice Address - Phone:619-254-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA287421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical