Provider Demographics
NPI:1154828887
Name:GARCES QUINTANA, ELENA ANTONIA
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:ANTONIA
Last Name:GARCES QUINTANA
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 1:10950 SPORTSMAN TRL
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-1160
Mailing Address - Country:US
Mailing Address - Phone:786-436-6121
Mailing Address - Fax:
Practice Address - Street 1:10950 SPORTSMAN TRL
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-1160
Practice Address - Country:US
Practice Address - Phone:786-436-6121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician