=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912434861
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONICA ORTEGA GARCIA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2017
-----------------------------------------------------
Last Update Date | 03/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15921 SW 302ND TER
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33033-3441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-830-1804
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8263 SW 107TH AVE APT B
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-3717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-830-1804
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | RBT1993767
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------