Provider Demographics
NPI:1982005641
Name:GARCIA, AGUSTINA M
Entity Type:Individual
Prefix:
First Name:AGUSTINA
Middle Name:M
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 1:5150 E PACIFIC COAST HWY
Mailing Address - Street 2:SUITE100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3312
Mailing Address - Country:US
Mailing Address - Phone:562-490-7600
Mailing Address - Fax:562-490-7601
Practice Address - Street 1:5150 E PACIFIC COAST HWY
Practice Address - Street 2:SUITE100
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3312
Practice Address - Country:US
Practice Address - Phone:562-490-7600
Practice Address - Fax:562-490-7601
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT105640106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist