Provider Demographics
NPI:1174990386
Name:GARZA, GUILLERMINA (LCSW)
Entity type:Individual
Prefix:
First Name:GUILLERMINA
Middle Name:
Last Name:GARZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 SAMPSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113-2312
Mailing Address - Country:US
Mailing Address - Phone:909-367-9354
Mailing Address - Fax:
Practice Address - Street 1:29645 RANCHO CALIFORNIA RD
Practice Address - Street 2:SUITE 133
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6200
Practice Address - Country:US
Practice Address - Phone:951-693-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA253181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical