Healthcare Provider Details

I. General information

NPI: 1265345458
Provider Name (Legal Business Name): MIA DESTINY GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIA DESTINY LARA

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11572 SHEEPSHEAD LN
JACKSONVILLE FL
32226-2191
US

IV. Provider business mailing address

11572 SHEEPSHEAD LN
JACKSONVILLE FL
32226-2191
US

V. Phone/Fax

Practice location:
  • Phone: 305-308-6780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: