Provider Demographics
NPI:1487001319
Name:GARCIA, JUAN LUIS
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:LUIS
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 1:11625 CANAL DR APT 18
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-3269
Mailing Address - Country:US
Mailing Address - Phone:786-521-8394
Mailing Address - Fax:
Practice Address - Street 1:11625 CANAL DR APT 18
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-3269
Practice Address - Country:US
Practice Address - Phone:786-521-8394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician