Provider Demographics
NPI:1124506837
Name:GARCIA, TAMARA (RBT-15-07902)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RBT-15-07902
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4196 E 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-2502
Mailing Address - Country:US
Mailing Address - Phone:305-527-7937
Mailing Address - Fax:
Practice Address - Street 1:6541 SW 112TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2070
Practice Address - Country:US
Practice Address - Phone:305-608-5572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-15-07902106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021094400Medicaid