Healthcare Provider Details

I. General information

NPI: 1033047477
Provider Name (Legal Business Name): MARCUS - GARCIA BRENEVILLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 LEE VISTA BLVD STE 700
ORLANDO FL
32822-5150
US

IV. Provider business mailing address

5451 VINELAND RD APT 2314
ORLANDO FL
32811-7630
US

V. Phone/Fax

Practice location:
  • Phone: 754-444-3707
  • Fax:
Mailing address:
  • Phone: 954-638-4874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-499198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: