Healthcare Provider Details

I. General information

NPI: 1649654161
Provider Name (Legal Business Name): IDALMYS GARCIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 22ND AVE NE
NAPLES FL
34120-5576
US

IV. Provider business mailing address

3620 22ND AVE NE
NAPLES FL
34120-5576
US

V. Phone/Fax

Practice location:
  • Phone: 239-316-9810
  • Fax:
Mailing address:
  • Phone: 239-316-9810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateFL

VIII. Authorized Official

Name: IDALMYS GARCIA
Title or Position: ADMINISTRATOR
Credential:
Phone: 239-316-9810