Provider Demographics
NPI:1508123340
Name:GARCIA, KIMIYO (BCBA)
Entity Type:Individual
Prefix:MS
First Name:KIMIYO
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11328 LAKELAND CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-6913
Mailing Address - Country:US
Mailing Address - Phone:239-628-6999
Mailing Address - Fax:
Practice Address - Street 1:11328 LAKELAND CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-6913
Practice Address - Country:US
Practice Address - Phone:239-691-6482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-20-42125103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100374200Medicaid