Provider Demographics
NPI:1376928507
Name:GARCIA, LUIS ALBERTO
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ALBERTO
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 NW 107TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5925
Mailing Address - Country:US
Mailing Address - Phone:305-597-3861
Mailing Address - Fax:305-597-3863
Practice Address - Street 1:13701 SW 88TH ST STE 305
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1309
Practice Address - Country:US
Practice Address - Phone:786-703-6218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-15-6739-28096106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician