Provider Demographics
NPI:1912434861
Name:ORTEGA GARCIA, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:ORTEGA GARCIA
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 1:8263 SW 107TH AVE APT B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3717
Mailing Address - Country:US
Mailing Address - Phone:786-830-1804
Mailing Address - Fax:
Practice Address - Street 1:15921 SW 302ND TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-3441
Practice Address - Country:US
Practice Address - Phone:786-830-1804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT1993767106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104424400Medicaid