Provider Demographics
NPI:1194061283
Name:GARCIA, GLADYS (BS, BCABA)
Entity type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:BS, BCABA
Other - Prefix:MISS
Other - First Name:GLADYS
Other - Middle Name:
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5694 MISSION CENTER RD
Mailing Address - Street 2:SUITE 602 PMB 341
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4355
Mailing Address - Country:US
Mailing Address - Phone:619-952-6786
Mailing Address - Fax:619-220-0215
Practice Address - Street 1:7852 MISSION CENTER COURT
Practice Address - Street 2:SUITE 322
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-952-6786
Practice Address - Fax:619-220-0215
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-12-5118103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst