Provider Demographics
NPI:1013366681
Name:GARCIA LARA, MABEL
Entity Type:Individual
Prefix:
First Name:MABEL
Middle Name:
Last Name:GARCIA LARA
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 1:5401 COLLINS AVE APT 526
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2532
Mailing Address - Country:US
Mailing Address - Phone:786-399-3989
Mailing Address - Fax:
Practice Address - Street 1:5401 COLLINS AVE APT 526
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2532
Practice Address - Country:US
Practice Address - Phone:786-399-3989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ11833235Z00000X
FL1-19-39245103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty