Provider Demographics
NPI:1295510055
Name:STA.ANA, IVIN JELL GARCIA
Entity type:Individual
Prefix:
First Name:IVIN JELL
Middle Name:GARCIA
Last Name:STA.ANA
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 1:464 DOHRMANN LN
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2370
Mailing Address - Country:US
Mailing Address - Phone:510-735-5353
Mailing Address - Fax:
Practice Address - Street 1:464 DOHRMANN LN
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2370
Practice Address - Country:US
Practice Address - Phone:510-735-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician