Provider Demographics
NPI:1447796800
Name:GARCIA, JOAQUIN (BS)
Entity Type:Individual
Prefix:MR
First Name:JOAQUIN
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14835 SW 45TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4326
Mailing Address - Country:US
Mailing Address - Phone:305-764-7114
Mailing Address - Fax:
Practice Address - Street 1:10550 NW 77TH CT STE 313-314
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-7084
Practice Address - Country:US
Practice Address - Phone:305-825-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 106S00000X
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician