Provider Demographics
NPI:1538773494
Name:GARCIA, NICOLE (PHD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 EVERETT ST APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4497
Mailing Address - Country:US
Mailing Address - Phone:951-224-3129
Mailing Address - Fax:
Practice Address - Street 1:3907 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1984
Practice Address - Country:US
Practice Address - Phone:951-224-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool