Healthcare Provider Details

I. General information

NPI: 1710697834
Provider Name (Legal Business Name): NINESKA D GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12985 SW 130TH CT UNIT 217
MIAMI FL
33186-5347
US

IV. Provider business mailing address

17384 SW 142ND CT
MIAMI FL
33177-2778
US

V. Phone/Fax

Practice location:
  • Phone: 786-581-9644
  • Fax:
Mailing address:
  • Phone: 786-709-5391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20-123199
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: