Provider Demographics
NPI:1790228997
Name:GARCIA, ROSE M
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:M
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 1:7200 BANCROFT AVE STE 125A
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2457
Mailing Address - Country:US
Mailing Address - Phone:510-777-3821
Mailing Address - Fax:
Practice Address - Street 1:7200 BANCROFT AVE STE 125A
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2457
Practice Address - Country:US
Practice Address - Phone:510-777-3821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health