MEDICARE: KOBY H GARCIA-LOPEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	BACB1433007	FL

General Provider Information

NPI Number	:	1447100110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOBY H GARCIA-LOPEZ

Provider Business Mailing Address
First Line	:	164 1ST AVE
Second Line	:
City	:	MARCO ISLAND
State	:	FL
Zip	:	34145-3614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 S MACDILL AVE # A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3131
Country	:	US
Telephone Number	:	813-475-4665
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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