Provider Demographics
NPI:1265031157
Name:GARCIA, RAQUEL DAETZ (RBT)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:DAETZ
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9430 SW 212TH TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3728
Mailing Address - Country:US
Mailing Address - Phone:786-246-1818
Mailing Address - Fax:
Practice Address - Street 1:11262 SW 230TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-7612
Practice Address - Country:US
Practice Address - Phone:786-246-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103922200Medicaid