Provider Demographics
NPI:1386879294
Name:GARCIA, ROBERT PATRICK
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:PATRICK
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W HALLANDALE BEACH BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5441
Mailing Address - Country:US
Mailing Address - Phone:305-216-0104
Mailing Address - Fax:954-458-2428
Practice Address - Street 1:221 W HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5441
Practice Address - Country:US
Practice Address - Phone:305-216-0104
Practice Address - Fax:954-458-2428
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL764499000Medicaid