Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LCS25250 | CA |
NPI | 1003149162 |
---|---|
Provider Name | John Garza |
First Address | Bakersfield, CA 93301-1407 |
Second Address | Bakersfield, CA 93301-1407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2009 |
Last Update Date | 08/09/2009 |