Provider Demographics
NPI:1750971537
Name:GARCIA, VICTORIA ALEJANDRA
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ALEJANDRA
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 1:4449 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-4520
Mailing Address - Country:US
Mailing Address - Phone:602-672-5274
Mailing Address - Fax:
Practice Address - Street 1:16629 N GREASEWOOD ST
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-3661
Practice Address - Country:US
Practice Address - Phone:928-503-3639
Practice Address - Fax:602-279-1431
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10625583104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker