Provider Demographics
NPI:1063760296
Name:GARCIA, SANDRA V
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:V
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDA
Other - Middle Name:V
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6851 LENNOX AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6851 LENNOX AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4073
Practice Address - Country:US
Practice Address - Phone:818-739-5469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363241041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA36324OtherASSOCIATE SOCIAL WORKER NUMBER