1194061283 NPI number — MRS. GLADYS GARCIA B.S., BCABA

Table of content: MRS. GLADYS GARCIA B.S., BCABA (NPI 1194061283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194061283 NPI number — MRS. GLADYS GARCIA B.S., BCABA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA
Provider First Name:
GLADYS
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
B.S., BCABA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AGUILAR
Provider Other First Name:
GLADYS
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194061283
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5694 MISSION CENTER RD
Provider Second Line Business Mailing Address:
SUITE 602 PMB 341
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92108-4355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-952-6786
Provider Business Mailing Address Fax Number:
619-220-0215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7852 MISSION CENTER COURT
Provider Second Line Business Practice Location Address:
SUITE 322
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-952-6786
Provider Business Practice Location Address Fax Number:
619-220-0215
Provider Enumeration Date:
12/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  0-12-5118 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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