Provider Demographics
NPI:1376159921
Name:GARCIA, LETICIA ALMAZAN
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:ALMAZAN
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 1:1370 STONEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-1550
Mailing Address - Country:US
Mailing Address - Phone:181-317-3419
Mailing Address - Fax:
Practice Address - Street 1:20401 SOLEDAD CANYON RD SPC 433
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-7177
Practice Address - Country:US
Practice Address - Phone:818-317-3419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5256225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist