Provider Demographics
NPI:1376304816
Name:GARCIA HERNANDEZ, RAIDI (RBT)
Entity Type:Individual
Prefix:
First Name:RAIDI
Middle Name:
Last Name:GARCIA HERNANDEZ
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 1:220 SW 9TH AVE APT 506
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5246
Mailing Address - Country:US
Mailing Address - Phone:542-842-6257
Mailing Address - Fax:
Practice Address - Street 1:220 SW 9TH AVE APT 506
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5246
Practice Address - Country:US
Practice Address - Phone:754-284-2625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-318559106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician