Healthcare Provider Details

I. General information

NPI: 1326873738
Provider Name (Legal Business Name): IVONNE IRENE ESPADA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10511 SW 88TH ST STE C103
MIAMI FL
33176-1546
US

IV. Provider business mailing address

840 NW 18TH AVE
MIAMI FL
33125-3519
US

V. Phone/Fax

Practice location:
  • Phone: 786-530-7427
  • Fax:
Mailing address:
  • Phone: 305-773-6068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-351017
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: