Provider Demographics
NPI:1801627211
Name:GARCIA, AMANDA HERMINDA (MSED)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:HERMINDA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 54TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-3142
Mailing Address - Country:US
Mailing Address - Phone:510-636-1400
Mailing Address - Fax:
Practice Address - Street 1:6328 E 17TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-3832
Practice Address - Country:US
Practice Address - Phone:510-879-3112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool