Provider Demographics
NPI:1780272195
Name:GARCIA, JENNIFER CHRISTINA (DPT)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CHRISTINA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22218 MCCLARREN ST
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5020
Mailing Address - Country:US
Mailing Address - Phone:909-489-0236
Mailing Address - Fax:
Practice Address - Street 1:22218 MCCLARREN ST
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5020
Practice Address - Country:US
Practice Address - Phone:909-489-0236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-02
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT299393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty