Provider Demographics
NPI:1114574050
Name:WOOD, DAVID GARCIA
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GARCIA
Last Name:WOOD
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 1:906 S DIXIE CT APT 105
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1169
Mailing Address - Country:US
Mailing Address - Phone:954-709-8745
Mailing Address - Fax:
Practice Address - Street 1:2701 W OAKLAND PARK BLVD STE 410-9
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1388
Practice Address - Country:US
Practice Address - Phone:305-389-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-95805106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician