Provider Demographics
NPI:1326807322
Name:GARCIA SAN JUAN, AILYN JR
Entity Type:Individual
Prefix:
First Name:AILYN
Middle Name:
Last Name:GARCIA SAN JUAN
Suffix:JR
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 1:5741 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2612
Mailing Address - Country:US
Mailing Address - Phone:786-270-7265
Mailing Address - Fax:
Practice Address - Street 1:5741 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2612
Practice Address - Country:US
Practice Address - Phone:786-270-7265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-24-15071106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst