Provider Demographics
NPI:1851197230
Name:VICTORES GARCIA, RAYDALIS DE LA
Entity type:Individual
Prefix:
First Name:RAYDALIS
Middle Name:DE LA
Last Name:VICTORES GARCIA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2352 SCHALL CIR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-3002
Mailing Address - Country:US
Mailing Address - Phone:561-420-5729
Mailing Address - Fax:
Practice Address - Street 1:500 S AUSTRALIAN AVE STE 600
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-6237
Practice Address - Country:US
Practice Address - Phone:877-857-8517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-414409106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician