Healthcare Provider Details

I. General information

NPI: 1104767151
Provider Name (Legal Business Name): KEYLA GARCIA MESA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9380 SW 72ND ST STE B224
MIAMI FL
33173-5460
US

IV. Provider business mailing address

11470 SW 1ST ST
MIAMI FL
33174-1032
US

V. Phone/Fax

Practice location:
  • Phone: 786-353-2593
  • Fax: 786-558-4097
Mailing address:
  • Phone: 786-813-6236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-522575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: