Provider Demographics
NPI:1487903522
Name:GARCIA, CAROLINA (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CAROLINA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 BROADWAY
Mailing Address - Street 2:STE. E
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5313
Mailing Address - Country:US
Mailing Address - Phone:619-600-4392
Mailing Address - Fax:619-240-3780
Practice Address - Street 1:713 BROADWAY
Practice Address - Street 2:STE. E
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5313
Practice Address - Country:US
Practice Address - Phone:619-600-4392
Practice Address - Fax:619-240-3780
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP14252235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist