Basic Information
| Provider Information | |||||||||
| NPI: | 1134640121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA DIAZ | ||||||||
| FirstName: | MAYRA | ||||||||
| MiddleName: | ALEXANDRA | ||||||||
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| Credential: | MSW | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | GARCIA | ||||||||
| OtherFirstName: | ALEXANDRA | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 393 E WALNUT ST | ||||||||
| Address2: | GPEU FL 3SCPMG | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911880001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776080044 | ||||||||
| FaxNumber: | 8775140903 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 N EL CENTRO AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900383805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237697199 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.