Provider Demographics
NPI:1417780693
Name:ANTY-GARCIA, JACKELYN
Entity type:Individual
Prefix:
First Name:JACKELYN
Middle Name:
Last Name:ANTY-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 1:12587 3RD ST
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-4542
Mailing Address - Country:US
Mailing Address - Phone:909-492-2839
Mailing Address - Fax:
Practice Address - Street 1:12587 3RD ST
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-4542
Practice Address - Country:US
Practice Address - Phone:909-492-2839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program