Provider Demographics
NPI:1366232894
Name:GARCIA GALLO, YAIZA
Entity type:Individual
Prefix:
First Name:YAIZA
Middle Name:
Last Name:GARCIA GALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 MONUMENT RD APT 1314
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-6455
Mailing Address - Country:US
Mailing Address - Phone:267-342-3087
Mailing Address - Fax:
Practice Address - Street 1:653 MONUMENT RD APT 1314
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6455
Practice Address - Country:US
Practice Address - Phone:267-342-3087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-434938106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty