Healthcare Provider Details

I. General information

NPI: 1659033900
Provider Name (Legal Business Name): MAURICIO GARCIA LOSADA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S INDIAN RIVER DR STE 237
FORT PIERCE FL
34950-4353
US

IV. Provider business mailing address

692 NW PLACID AVE
PORT ST LUCIE FL
34983-1012
US

V. Phone/Fax

Practice location:
  • Phone: 305-795-0600
  • Fax:
Mailing address:
  • Phone: 305-795-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: