Provider Demographics
NPI:1154837490
Name:GARCIA, ALEIDA
Entity Type:Individual
Prefix:
First Name:ALEIDA
Middle Name:
Last Name: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 1:18521 E QUEEN CREEK RD STE 105-627
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5870
Mailing Address - Country:US
Mailing Address - Phone:480-361-1025
Mailing Address - Fax:480-814-7488
Practice Address - Street 1:18521 E QUEEN CREEK RD STE 105-627
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5870
Practice Address - Country:US
Practice Address - Phone:480-361-1025
Practice Address - Fax:480-814-7488
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRBT-17-43868106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician