Provider Demographics
NPI:1487877338
Name:GARCIA, ANTONETTE -
Entity type:Individual
Prefix:
First Name:ANTONETTE
Middle Name:-
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:-
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADC-II, CSAC-II
Mailing Address - Street 1:PO BOX 188871
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-8871
Mailing Address - Country:US
Mailing Address - Phone:916-451-6934
Mailing Address - Fax:916-451-6934
Practice Address - Street 1:3042 MARSHALL WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2735
Practice Address - Country:US
Practice Address - Phone:916-451-6934
Practice Address - Fax:916-451-6934
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA8455604101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3941646OtherKAISER NUMBER