Provider Demographics
NPI:1417475765
Name:GARCIA, JACZAN (RBT)
Entity Type:Individual
Prefix:
First Name:JACZAN
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:JACZAN
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:55 NE 5TH ST UNIT 3505
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-2034
Mailing Address - Country:US
Mailing Address - Phone:305-586-7801
Mailing Address - Fax:
Practice Address - Street 1:55 NE 5TH ST UNIT 3505
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-2034
Practice Address - Country:US
Practice Address - Phone:305-586-7801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022908800Medicaid