Provider Demographics
NPI:1871877746
Name:GARCIA-IXCOL, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:GARCIA-IXCOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 S AVENUE 24 STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-2299
Mailing Address - Country:US
Mailing Address - Phone:323-974-9148
Mailing Address - Fax:
Practice Address - Street 1:163 S AVENUE 24 STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2299
Practice Address - Country:US
Practice Address - Phone:323-974-9148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67441106H00000X
CA1112063106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist