Provider Demographics
NPI:1962263962
Name:MARICHAL GARCIA, GLADYS
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:MARICHAL 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 1:3418 W 110TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-2179
Mailing Address - Country:US
Mailing Address - Phone:786-804-0713
Mailing Address - Fax:
Practice Address - Street 1:9370 SW 72ND ST STE A200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5452
Practice Address - Country:US
Practice Address - Phone:786-488-9954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician