Healthcare Provider Details

I. General information

NPI: 1033763602
Provider Name (Legal Business Name): YOSLANDY GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12700 SW 122ND AVE STE 110
MIAMI FL
33186-5271
US

IV. Provider business mailing address

19310 NW 82ND CT
HIALEAH FL
33015-5300
US

V. Phone/Fax

Practice location:
  • Phone: 786-353-2900
  • Fax: 786-364-1676
Mailing address:
  • Phone: 786-537-0894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-56812
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: