Basic Information
Provider Information
NPI: 1811610363
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARCIA
FirstName: VERONICA
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3810 ROSIN CT STE 180
Address2:  
City: SACRAMENTO
State: CA
PostalCode: 958341658
CountryCode: US
TelephoneNumber: 9162838280
FaxNumber: 9162838259
Practice Location
Address1: 3440 VIKING DR
Address2:  
City: SACRAMENTO
State: CA
PostalCode: 958272844
CountryCode: US
TelephoneNumber: 9162628598
FaxNumber: 9162628599
Other Information
ProviderEnumerationDate: 09/20/2022
LastUpdateDate: 09/20/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/20/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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