Provider Demographics
NPI:1912768474
Name:GARCIA, ELIATA IMELDA
Entity Type:Individual
Prefix:MRS
First Name:ELIATA
Middle Name:IMELDA
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 1:2761 LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-3734
Mailing Address - Country:US
Mailing Address - Phone:916-868-8831
Mailing Address - Fax:
Practice Address - Street 1:2761 LARKSPUR LN APT 4
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-3761
Practice Address - Country:US
Practice Address - Phone:916-868-8831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician