Provider Demographics
NPI:1437922861
Name:GARCIA-GUTIERREZ, SERGIO (LMT)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:GARCIA-GUTIERREZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 W 16TH AVE APT 509
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4567
Mailing Address - Country:US
Mailing Address - Phone:929-300-6000
Mailing Address - Fax:
Practice Address - Street 1:6175 NW 153RD ST STE 204
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2435
Practice Address - Country:US
Practice Address - Phone:786-536-7280
Practice Address - Fax:888-412-1788
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA101704225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist