Provider Demographics
NPI:1700562394
Name:GARCIA JARACUARO, GLORIA YEDIT (ASW123639)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:YEDIT
Last Name:GARCIA JARACUARO
Suffix:
Gender:F
Credentials:ASW123639
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3117 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-5319
Mailing Address - Country:US
Mailing Address - Phone:661-324-4756
Mailing Address - Fax:661-617-2099
Practice Address - Street 1:3117 WILSON RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-5319
Practice Address - Country:US
Practice Address - Phone:661-324-4756
Practice Address - Fax:661-617-2099
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2025-05-19
Deactivation Date:2024-05-28
Deactivation Code:
Reactivation Date:2025-05-19
Provider Licenses
StateLicense IDTaxonomies
CAASW123639104100000X
101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health