Provider Demographics
NPI:1255872990
Name:GARCIA, LISETTE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISETTE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:LISETTE
Other - Middle Name:
Other - Last Name:GARCIA VEGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:27125 LAMDIN AVE
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-9097
Mailing Address - Country:US
Mailing Address - Phone:951-440-7566
Mailing Address - Fax:
Practice Address - Street 1:26091 MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-6401
Practice Address - Country:US
Practice Address - Phone:951-765-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42982355A2700X
CA31885235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant