Provider Demographics
NPI:1558917039
Name:MOSQUERA GARCIA, AYDELIS (RBT)
Entity Type:Individual
Prefix:
First Name:AYDELIS
Middle Name:
Last Name:MOSQUERA GARCIA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 BURLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-3617
Mailing Address - Country:US
Mailing Address - Phone:720-318-2035
Mailing Address - Fax:305-675-8040
Practice Address - Street 1:1130 BURLINGTON ST
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-3617
Practice Address - Country:US
Practice Address - Phone:720-318-2035
Practice Address - Fax:305-675-8040
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician