Provider Demographics
NPI:1215644455
Name:GARCIA, CECILIA CARLOTA
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:CARLOTA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 VALLEY VIEW RD APT 12
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5850
Mailing Address - Country:US
Mailing Address - Phone:408-659-9435
Mailing Address - Fax:
Practice Address - Street 1:1560 VALLEY VIEW RD APT 12
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5850
Practice Address - Country:US
Practice Address - Phone:408-659-9435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARADTI1480010822101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARADTI1480010822OtherCCAPP