Provider Demographics
NPI:1891250544
Name:GARCIA, GERARDO OCTAVIO (APCC)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:OCTAVIO
Last Name:GARCIA
Suffix:
Gender:M
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9025 COROMAR CT
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-6130
Mailing Address - Country:US
Mailing Address - Phone:805-550-9553
Mailing Address - Fax:
Practice Address - Street 1:9025 COROMAR CT
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-6130
Practice Address - Country:US
Practice Address - Phone:805-550-9553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC5991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health