Healthcare Provider Details

I. General information

NPI: 1578390571
Provider Name (Legal Business Name): TEDDY GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28410 BONITA CROSSINGS BLVD UNIT 150
BONITA SPRINGS FL
34135-3217
US

IV. Provider business mailing address

13581 EAGLE RIDGE DR APT 1426
FORT MYERS FL
33912-6814
US

V. Phone/Fax

Practice location:
  • Phone: 239-451-7163
  • Fax: 239-310-2045
Mailing address:
  • Phone: 239-895-4058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-377333
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: