Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003068255 |
---|---|
Provider Name | Mr. Augustine Antonio Garcia JR. |
First Address | Sacramento, CA 95816-4421 |
Second Address | Sacramento, CA 95826-3221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2008 |
Last Update Date | 26/05/2009 |